Abstract TP142: Factors Influencing Post-stroke Discharge to Institutional Rehabilitation Settings versus Home

Abstract

Introduction: We assessed relative impacts of sociodemographic, clinical, and geographic factors on discharge to rehabilitation or home in a population-based stroke study. Methods: Stroke survivors were identified from 2011-2013 in the Brain Attack Surveillance in Corpus Christi (BASIC) Project (death<30 days or nursing home residence excluded). Sociodemographic factors (age, sex, ethnicity, insurance type), clinical factors (risk factors, comorbidities, NIH Stroke Scale), and discharge location (inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), home) were collected from medical records and interviews. Geographic factors were distance to nearest IRF/SNF and number of IRF/SNFs within 5 miles of the survivor’s home. Multinomial logistic regression models were used to calculate probabilities of discharge to IRF, SNF, and home for each factor set, fixing the other two factors at their means. High vs low probabilities (25 vs 75 percentile) of discharge to IRF, SNF, and home were compared to show the impact of each factor set. Results: Discharge location was available for 796/942 (85%) survivors; 15% were discharged to IRF, 26% SNF, and 59% home. Median age was 68 (IQR 58-79); 64% were Mexican American and 36% non-Hispanic white. High/low probabilities of discharge to IRF differed by 2% for sociodemographic factor variation, 7% for clinical factors, and 9% for geographic factors; probabilities of discharge to SNF differed by 22% for sociodemographic factor variation, 14% for clinical factors, and 6% for geographic factors; and probabilities of discharge home differed by 25% for sociodemographic factor variation, 24% for clinical factors, and 6% for geographic factors. Conclusion: The probability of discharge to IRF is most affected by variation in clinical factors; discharge to SNF by sociodemographic factors; and discharge home by sociodemographic and clinical factors. Geographic factors do not substantially affect discharge location.