Abstract
Nursing home placement after stroke indicates a poor outcome but numbers placed vary between hospitals. The aim of this study is to determine whether between-hospital variations in new nursing home placements post-stroke are reliant solely on case-mix differences or whether service heterogeneity plays a role. A prospective, multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospitals within the Anglia Stroke and Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospitals (as a fixed-effect) and rates of new discharges to nursing homes using multiple logistic regression, adjusting for important patient risk factors. Descriptive and graphical data analyses were undertaken to explore the role of hospital characteristics. Of 1335 stroke admissions, 135 (10%) were discharged to a nursing home but rates varied considerably from 6% to 19% between hospitals. The hospital with the highest adjusted odds ratio of nursing home discharges (OR 4.26; 95% CI 1.69 to 10.73), was the only hospital that did not provide rehabilitation beds in the stroke unit. Increasing hospital size appeared to be related to an increased odds of nursing home placement, although attenuated by the number of hospital stroke admissions. Our results highlight the potential influence of hospital characteristics on this important outcome, independently of patient-level factors.
Highlights
Stroke is the second leading cause of mortality and the third leading cause of disability worldwide [1]
A multi-centre, prospective cohort study conducted at eight acute NHS hospitals within the Anglia Stroke and Heart Clinical Network (AS&HCN) which participated in the Anglia Stroke Clinical
All other hospitals were associated with greater odds of nursing home placement than hospital 1, none reached statistical significance
Summary
Stroke is the second leading cause of mortality and the third leading cause of disability worldwide [1]. Given the significant impact that a stroke can have on the ability to perform daily tasks, many patients require institutionalization. In the UK, for example, 8.2% of patients surviving stroke are discharged to a care home [2]. Changing demographics, improvements in stroke care and Healthcare 2020, 8, 390; doi:10.3390/healthcare8040390 www.mdpi.com/journal/healthcare. Healthcare 2020, 8, 390 post-acute care provision (i.e., widespread incorporation of early supported discharge policies) have led to a significant reduction in institutionalization rates since 1995 [3]. Home discharge is the most desirable outcome following stroke; 85% of patients in a previous study favored returning home for reasons such as increased autonomy and privacy [4]. Greater long-term improvements have been observed in patients that return home [5]
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