Factors associated with home discharge among veterans with stroke.

Kurichi JE, Xie D, Bates BE, Ripley DC, Vogel WB, Kwong P, Stineman MG. Factors associated with home discharge among veterans with stroke. Archives of physical medicine and rehabilitation. 2014 Jul 1; 95(7):1277-1282.e3.

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Abstract:

OBJECTIVE: To determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs. DESIGN: Retrospective observational study. SETTING: Veterans Affairs facilities nationwide. PARTICIPANTS: Veterans hospitalized for stroke during fiscal year 2007 to fiscal year 2008 (N = 12,565). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Discharge location after hospitalization. RESULTS: There were 10,130 (80.6%) veterans discharged home after hospitalization for acute stroke. Married veterans were more likely than nonmarried veterans to be discharged home (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.11-1.35). Compared with veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR = .04; 95% CI = .03-.07). Compared with those with occlusion of cerebral arteries, patients with intracerebral hemorrhage (OR = .61; 95% CI = .50-.74) or other central nervous system hemorrhage (OR = .78; 95% CI = .63-.96) were less likely to be discharged home, whereas patients with occlusion of precerebral arteries (OR = 1.36; 95% CI = 1.07-1.73) were more likely to return home. Evidence of congestive heart failure (OR = .85; 95% CI = .76-.95), fluid and electrolyte disorders (OR = .86; 95% CI = .77-.96), internal organ procedures and diagnostics (OR = .87; 95% CI = .78-.97), and serious nutritional compromise (OR = .49; 95% CI = .40-.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated, whereas treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge. CONCLUSIONS: We found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning.