Factors Associated With Differences in the Recommended Versus Actual Discharge Location After Stroke.

Abstract

Discharge planning during an acute stroke hospitalization requires a coordinated effort to ensure patients receive the most appropriate posthospital care. We identified and described discrepancies in recommended versus actual postdischarge care after stroke. This retrospective cohort study used the final acute hospital discharge recommendation by physical and occupational therapy as the recommended discharge disposition. We identified those who were discharged to a different care setting than was recommended and characterized sociodemographic, clinical, and facility factors associated with this discrepancy using a multinomial logistic regression. Acute care. Individuals hospitalized for an ischemic or hemorrhagic stroke between January 1, 2018, and December 31, 2024. The cohort (N=7545) comprised stroke hospitalizations. Not applicable. The recommended and actual discharge disposition. TThe mean (SD) age was 67 (14) years, 45.2% White and 42.0% Black. Overall, 1182 (15.6%) discharges were discrepant: 950 (80.4%) went to a lower intensity care setting, and 232 (19.6%) went to a higher intensity setting. The strongest associations with a discrepant discharge were a Sunday discharge (odds ratio [OR], 1.53; 95% CI, 1.10-2.11), Medicare fee-for-service (OR, 1.43; 95% CI, 1.14-1.79), or Medicare Advantage insurance (OR, 1.34; 95% CI, 1.08-1.68), and dependent prestroke ambulation (OR, 1.38; 95% CI, 1.14-1.68). These were also the factors most associated with increased odds of discharge to a lower intensity setting. A severe stroke (OR, 0.80; 95% CI, 0.67-0.96) and physiatry consult (OR, 0.75; 95% CI, 0.64-0.89) were associated with significantly lower odds of a discrepant discharge. Hemorrhagic stroke, increased function during admission, and greater social vulnerability were associated with increased odds of discharge to a higher intensity setting. The factors most associated with differences in recommended versus actual postacute care were unrelated to clinical need. Addressing these underlying factors will help ensure patients receive the recommended care to maximize outcomes.