Factors associated with community versus personal care home discharges after inpatient stroke rehabilitation: the need for a pre-admission predictive model

ABSTRACT

Background: Improved risk factor management and interventions have both been shown to improve mortality in stroke patients. Although this has been a success for acute care, it has placed a higher burden on stroke rehabilitation resources.

Objectives: This study sought to identify the pre-stroke rehabilitation admission factors that best predict personal care home discharge.

Methods: Using a retrospective case-control, chart review design, 60 patients discharged to personal care homes from inpatient stroke rehabilitation between 2008 and 2017 were included. One hundred and eighty-two patients discharged home over the same time span were randomly selected as controls. Statistical analysis was used to identify patient factors independently associated with discharge destination.

Results: Patients were more often discharged to personal care homes if they were older (OR 1.09; CI [1.05–1.15]), had a lower functional independence measure score (OR 0.95; CI [0.92–0.97]), had cognitive deficits (OR 6.19; CI [2.37–18.06]), lived alone before their stroke (OR 7.77; CI [2.75–24.55]), and whether or not there was excessive truncal instability limiting Berg balance scale measurability (OR 0.17; CI [0.06–0.45] if able to measure). Combined, the predictive value of personal care home discharge using these variables was 91.6%.

Conclusions: A combination of age, admission functional independence measure, cognitive impairment, pre-stroke living situation, and measurability of the Berg balance scale on admission to stroke rehabilitation were highly predictive of eventual personal care home discharge.

KEYWORDS:

• Outcomes
• disability
• discharge destination
• long term care
• caregivers
• assessment

Acknowledgments

Brenden Dufault, University of Manitoba, Canada – Statistical analysis and guidance for write-up.

Kanisha Cruz-Kan, Medical Student, Faculty of Medicine, University of Manitoba, Canada – Data collection.

Himath Jayasinghe, Medical Student, Faculty of Medicine, University of Manitoba, Canada – Data collection.

Declaration of permission to publish personal information

The authors authorize this journal to publish the personal information of the authors in conjunction with the submitted journal article.