Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-05T23:21:44.877Z Has data issue: false hasContentIssue false

Exploring discharge destination following severe stroke

Published online by Cambridge University Press:  02 April 2020

Wei Lin Teoh
Affiliation:
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
Emma Finch*
Affiliation:
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
*
*Corresponding author. Email: e.finch@uq.edu.au
Get access

Abstract

Background:

Patients with severe stroke frequently present with substantial impairments but are often not prioritised for post-discharge rehabilitation. There is a need to determine where these patients are discharged to in order to facilitate appropriate allocation of post-discharge pathway resources.

Aim:

The present study aimed to describe the discharge pathways of patients with severe stroke and to identify predictors of discharge destination for these patients.

Method:

A descriptive, retrospective design was utilised to determine the discharge destination for 770 patients with severe stroke in Queensland, Australia. Binomial logistic regression was used to determine the variables that predicted discharge destination.

Results:

The results indicated that 58.44% of patients were discharged home (n = 450). Age, length of stay, discharge ward and geographical region emerged as significant predictors of discharge destination. The full model containing all predictors was statistically significant and, as a whole, explained 36.50% of the variance in discharge destination.

Conclusion:

These results highlight the importance of these variables in influencing the outcomes of patients with severe stroke, which may assist post-hospital discharge services in allocating resources for patients with severe stroke.

Type
Articles
Copyright
© Australasian Society for the Study of Brain Impairment 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Bureau of Statistics. (2016). 1270.0.55.005 – Australian Statistical Geography Standard (ASGS): Volume 5 – Remoteness Structure, July 2016. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/1270.0.55.005Main%20Features15July%202016?opendocument&tabname=Summary&prodno=1270.0.55.005&issue=July%202016&num=&view=.Google Scholar
Australian Bureau of Statistics. (2017). Australian Statistical Geography Standard (ASGS). Retrieved from http://www.abs.gov.au/websitedbs/D3310114.nsf/home/Australian+Statistical+Geography+Standard+(ASGS).Google Scholar
Australian Bureau of Statistics. (2018). 3101.0 - Australian Demographic Statistics, September 2017. LATEST ISSUE Released at 11:30 AM (CANBERRA TIME) 22/03/2018. Retrieved 24 April 2018, from http://www.abs.gov.au/ausstats/abs@.nsf/mf/3101.0.Google Scholar
Barker, R. N., Brauer, S., & Carson, R. (2009). Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke. Experimental Brain Research, 196(4), 483496.Google Scholar
Bindawas, S. M., Mawajdeh, H., Vennu, V., & Alhaidary, H. (2016). A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia. Medicine, 95(31), e4432. doi: 10.1097/MD.0000000000004432.Google Scholar
Bourell, L., & Turner, M. D. (2010). Management of in-flight medical emergencies. Journal of Oral and Maxillofacial Surgery, 68(6). 13771383. doi: 10.1016/j.joms.2009.07.057.Google Scholar
Camicia, M., Wang, H., DiVita, M., Mix, J., & Niewczyk, P. (2016). Length of stay at inpatient rehabilitation facility and stroke patient outcomes. Rehabilitation Nursing, 41(2), 7890. doi: 10.1002/rnj.218.Google Scholar
Deb, R., Reddy, K. S., Alam, M. I., Razvi, S., Paul, R., Babu, R., … Prabhakar, S. (2014). Influence of age, gender, stroke sub type and stroke severity on length of hospital stay in patients with acute stroke. Paper presented at the Twenty Seventh Annual Congress of the European Society of Intensive Care Medicine, Barcelona, Spain. Abstract retrieved from https://link-springer-com.ezproxy.library.uq.edu.au/content/pdf/10.1007%2Fs00134-014-3451-0.pdf.Google Scholar
Elwood, D., Rashbaum, I., Bonder, J., Pantel, A., Berliner, J., Yoon, S., … Bansal, A. (2009). Length of stay in rehabilitation is associated with admission neurologic deficit and discharge destination. Physical Medicine and Rehabilitation, 1(2), 147151. doi: 10.1016/j.pmrj.2008.10.010.Google Scholar
Freburger, J. K., Holmes, G. M., Ku, L. E., Cutchin, M. P., Heatwole-Shank, K., & Edwards, L. J. (2011). Disparities in postacute rehabilitation care for stroke: An analysis of the state inpatient databases. Archives of Physical Medicine and Rehabilitation, 92(8), 12201229. doi: 10.1016/j.apmr.2011.03.019.Google Scholar
Frontera, J. A., Egorova, N., & Moskowitz, A. J. (2011). National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998–2007. Critical Care Medicine, 39(7), 16191625. doi: 10.1097/CCM.0b013e3182186ed6.Google Scholar
González-Fernández, M., Christian, A. B., Davis, C., & Hillis, A. E. (2013). Role of aphasia in discharge location after stroke Archives of physical medicine and rehabilitation, 94(5), 851855. doi: 10.1097/01.phm.0000237870.07136.24.Google Scholar
Gregory, P. C., & Han, E. (2009). Disparities in postacute stroke rehabilitation disposition to acute inpatient rehabilitation vs. home: Findings from the North Carolina hospital discharge database. American Journal of Physical Medicine & Rehabilitation, 88(2), 100107. doi: 10.1097/PHM.0b013e3181951762.Google Scholar
Gregory, P. C., Han, E., Morozova, O., & Kuhlemeier, K. V. (2006). Do racial disparities exist in access to inpatient stroke rehabilitation in the state of Maryland? American Journal of Physical Medicine & Rehabilitation, 85(10), 814819. doi: 10.1097/01.phm.0000237870.07136.24.Google Scholar
Hakkennes, S. J., Brock, K., & Hill, K. D. (2011). Selection for inpatient rehabilitation after acute stroke: A systematic review of the literature. Archives of Physical Medicine and Rehabilitation, 92(12), 20572070. doi: 10.1016/j.apmr.2011.07.189.Google Scholar
Hakkennes, S., Hill, K. D., Brock, K., Bernhardt, J., & Churilov, L. (2012). Accessing inpatient rehabilitation after acute severe stroke: Age, mobility, prestroke function and hospital unit are associated with discharge to inpatient rehabilitation. International Journal of Rehabilitation Research, 35(4), 323329. doi: 10.1097/MRR.0b013e328355dd00.Google Scholar
Hakkennes, S., Hill, K. D., Brock, K., Bernhardt, J., & Churilov, L. (2013). Selection for inpatient rehabilitation after severe stroke: What factors influence rehabilitation assessor decision-making? Journal of Rehabilitation Medicine, 45(1), 2431. doi: 10.2340/16501977-1065.CrossRefGoogle ScholarPubMed
Ilett, P. A., Brock, K. A., Graven, C. J., & Cotton, S. M. (2010). Selecting patients for rehabilitation after acute stroke: Are there variations in practice? Archives of Physical Medicine and Rehabilitation, 91(5), 788793. doi: 10.1016/j.apmr.2009.11.028.Google Scholar
Katrak, P. H., Black, D., & Peeva, V. (2009). Do stroke patients with intracerebral hemorrhage have a better functional outcome than patients with cerebral infarction? Physical Medicine and Rehabilitation, 1(5), 427433. doi: 10.1016/j.pmrj.2009.03.002.Google Scholar
Koyama, T., Sako, Y., Konta, M., & Domen, K. (2011). Poststroke discharge destination: Functional independence and sociodemographic factors in urban Japan. Journal of Stroke and Cerebrovascular Diseases, 20(3), 202207. doi: 10.1016/j.jstrokecerebrovasdis.2009.11.020.Google Scholar
Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 16931702. doi: 10.1016/S0140-6736(11)60325-5.Google Scholar
Lynch, E. A., Luker, J. A., Cadilhac, D., & Hillier, S. L. (2016). Inequities in access to rehabilitation: Exploring how acute stroke unit clinicians decide who to refer to rehabilitation. Disability and Rehabilitation, 38(14), 14151424. doi: 10.3109/09638288.2015.1103791.Google Scholar
Maaijwee, N. A., Rutten-Jacobs, L. C., Schaapsmeerders, P., Van Dijk, E. J., & de Leeuw, F. E. (2014). Ischaemic stroke in young adults: Risk factors and long-term consequences. Nature Reviews Neurology, 10(6), 315.Google Scholar
Marquardt, D. W. (1970). Generalized inverses, ridge regression, biased linear estimation, and nonlinear estimation. Technometrics, 12(3), 591612. doi: 10.2307/1267205.Google Scholar
Mayo, N. E., Hendlisz, J., Goldberg, M. S., Korner-Bitensky, N., Becker, R., & Coopersmith, H. (1989). Destinations of stroke patients discharged from the Montreal area acute-care hospitals. Stroke, 20(3), 351356. doi: 10.1161/01.STR.20.3.351.CrossRefGoogle ScholarPubMed
Mees, M., Klein, J., Yperzeele, L., Vanacker, P., & Cras, P. (2016). Predicting discharge destination after stroke: A systematic review. Clinical Neurology and Neurosurgery, 142, 1521. doi: 10.1016/j.clineuro.2016.01.004.Google Scholar
Meijer, R., Ihnenfeldt, D. S., van Limbeek, J., Vermeulen, M., & de Haan, R. J. (2003). Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature. Clinical Rehabilitation, 17(5), 512520. doi: 10.1191/0269215503cr644oa.Google Scholar
Mirkowski, M., Pereira, S., Janzen, S., Mehta, S., Meyer, M., McClure, A., … Teasell, R. (2018). Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation. Disability and Rehabilitation, 40(4), 457461.Google Scholar
Nuyen, J., Spreeuwenberg, P. M., Groenewegen, P. P., van den Bos, G. A. M., & Schellevis, F. G. (2008). Impact of preexisting depression on length of stay and discharge destination among patients hospitalized for acute stroke: Linked register-based study. Stroke, 39(1), 132138. doi: 10.1161/STROKEAHA.107.490565.Google Scholar
Ohwaki, K., Hashimoto, H., Sato, M., Tokuda, H., & Yano, E. (2005). Gender and family composition related to discharge destination and length of hospital stay after acute stroke. Tohoku Journal of Experimental Medicine, 207(4), 325332. doi: 10.1620/tjem.207.325.Google Scholar
Onukwugha, E., & Mullins, C. D. (2007). Racial differences in hospital discharge disposition among stroke patients in Maryland. Medical Decision Making, 27(3), 233242. doi: 10.1177/0272989X07302130.Google Scholar
Pereira, S., Foley, N., Salter, K., McClure, J. A., Meyer, M., Brown, J., … Teasell, R. (2014). Discharge destination of individuals with severe stroke undergoing rehabilitation: A predictive model. Disability and Rehabilitation, 36(9), 727731. doi: 10.3109/09638288.2014.902510.Google Scholar
Pereira, S., Graham, J. R., Shahabaz, A., Salter, K., Foley, N., Meyer, M., & Teasell, R. (2012). Rehabilitation of individuals with severe stroke: Synthesis of best evidence and challenges in implementation. Topics in Stroke Rehabilitation, 19(2), 122131. doi: 10.1310/tsr1902-122.CrossRefGoogle ScholarPubMed
Philbrick, J. T., Shumate, R., Siadaty, M. S., & Becker, D. M. (2007). Air travel and venous thromboembolism: A systematic review. Journal of General Internal Medicine, 22(1), 107114. doi: 10.1007/s11606-006-0016-0.Google Scholar
Pukelsheim, F. (1994). The three sigma rule. The American Statistician, 48(2), 8891. doi: 10.2307/2684253.Google Scholar
Queensland Legislation. (2005). Public Health Act. Retrieved from https://www.legislation.qld.gov.au/view/whole/html/inforce/current/act-2005-048.Google Scholar
Stein, J., Bettger, J. P., Sicklick, A., Hedeman, R., Magdon-Ismail, Z., & Schwamm, L. H. (2015). Use of a standardized assessment to predict rehabilitation care after acute stroke. Archives of Physical Medicine and Rehabilitation, 96(2), 210217. doi: 10.1016/j.apmr.2014.07.403.Google Scholar
Sutherland, J. M., & Walker, J. (2008). Challenges of rehabilitation case mix measurement in Ontario hospitals. Health Policy, 85(3), 336348. doi: 10.1016/j.healthpol.2007.09.006.Google Scholar
Tabernig, C. B., Lopez, C. A., Carrere, L. C., Spaich, E. G., & Ballario, C. H. (2018). Neurorehabilitation therapy of patients with severe stroke based on functional electrical stimulation commanded by a brain computer interface. Journal of Rehabilitation and Assistive Technologies Engineering, 5, 2055668318789280.Google Scholar
Teasell, R. W., Foley, N. C., Bhogal, S. K., Chakravertty, R., & Bluvol, A. (2005). A rehabilitation program for patients recovering from severe stroke. Canadian Journal of Neurological Sciences, 32(4), 512517. doi: 10.1017/S0317167100004534.Google Scholar
Tinl, M. L., Kale, M. K., Doshi, S., Guarino, A. J., & Beninato, M. (2014). The Mobility Scale for Acute Stroke predicts discharge destination after acute hospitalisation. Journal of Rehabilitation Medicine, 46(3), 219224. doi: 10.2340/16501977-1269.Google Scholar
van Bragt, P. J., van Ginneken, B. T., Westendorp, T., Heijenbrok-Kal, M. H., Wijffels, M. P., & Ribbers, G. M. (2014). Predicting outcome in a postacute stroke rehabilitation programme. International Journal of Rehabilitation Research, 37(2), 110117. doi: 10.1097/MRR.0000000000000041.Google Scholar
van der Cruyssen, K., Vereeck, L., Saeys, W., & Remmen, R. (2015). Prognostic factors for discharge destination after acute stroke: A comprehensive literature review. Disability and Rehabilitation, 37(14), 12141227. doi: 10.3109/09638288.2014.961655.Google Scholar
Ween, J. E., Alexander, M. P., D’Esposito, M., & Roberts, M. (1996). Factors predictive of stroke outcome in a rehabilitation setting. Neurology, 47(2), 388392. doi: 10.1212/WNL.47.2.388.Google Scholar
World Heart Federation. (2016). Stroke. Retrieved from http://www.world-heart-federation.org/cardiovascular-health/stroke/.Google Scholar