Abstract 2467: Factors Affecting the Discharge Disposition after Stroke

Abstract

Background and Purpose: Stroke is the third leading cause of death and is the leading cause of adult disability in Taiwan. Stroke patients are frequently in need of professional care and assistance in activities of daily living. Home care may not provide adequate support for some of the disabled stroke patients. Discharge disposition after stroke is an important long-term care issue affecting the families and societies in every country, developed or developing. We have made analyses of more than 20,000 disposition arrangements 3 month after stroke in the Taiwan Stroke Registry to explore key demographic and clinical factors that may determine the disposition. Methods: The Taiwan Stroke Registry (TSR), sponsored by Taiwan Department of Health and engaging 39 academic and community hospitals, covers broadly the entire country with 4 steps of quality control to ensure reliability of entered data (Hsieh FI et al, Circulation, 2010). The 3 month follow-up data of 21,786 stroke admissions between 2006 and 2008 was used for analysis. Under the stratification of age and separating discharge destinations into home and nursing home, we investigated the influences of patients’ demographics, clinical characteristics, and disability levels by the Cochran-Mantel-Haenszel method. We calculated the odds ratios of factors of significant impact based on the multiple logistic regression model. Results: Education level, living place, main caregiver, hypertension, diabetes mellitus, heart diseases, previous stroke history, snoring, stroke types, length of stay, rehabilitation, number of complications (pneumonia, urinary tract infection, or upper gastrointestinal bleeding), and National Institute of Health Stroke Scale (NIHSS) significantly affect the discharge dispositions (p<0.05) after adjustment by age. Independent from the above variables, age carries a high impact based on yearly increase (1.02, 95% CI=1.01-1.03). Male gender (1.57, 1.35-1.82), education (0.81, 0.69-0.96), location of residence (1.70, 1.45-2.00), availability of employed caregivers (2.19, 1.82-2.63), snoring (0.84, 0.71-0.99), hemorrhagic stroke (1.46, 1.22-1.75), increase of length of stay by one day (1.01, 1.005-1.015), rehabilitation (0.78, 0.61-0.98), one complication (1.56, 1.32-1.84), and increase in NIHSS by one point (1.14, 1.13-1.15). Conclusions: Results showing relative weight of key determinants of patient disposition 3 months after stroke may be useful in acute care of stroke patients in facilitating disposition and in planning long-term care preparation from the perspective of individual families, institutions caring for stroke patients and the government agencies. Whether findings derived from the present study are applicable across countries remain to be determined.