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Background: Discharge destination after acute ischemic stroke has implications for functional recovery and healthcare costs. Individuals discharged to inpatient rehabilitation facilities (IRFs) achieve better outcomes than those discharged to skilled nursing facilities (SNFs); however, many patients discharged to IRFs and SNFs have similar clinical profiles. We examined non-clinical factors associated with discharge location after acute ischemic stroke. Methods: Population: 236 adults hospitalized with acute ischemic stroke, living independently in the community prior to admission, and discharged to either an IRF (n=171) or SNF (n=65). Clinical variables: NIHSS, Charlson Comorbidity Index (CCI), acute care length of stay (LOS), functional status (AM-PAC "6-Clicks"), and neglect. Non-clinical variables: age, sex, race, marital status, insurance, home layout, living status, and available assistance. Associations with discharge location were evaluated using univariable and multivariable logistic regression and reported as odds ratios (OR) with 95% confidence intervals (CI). Results: Individuals discharged to IRFs were younger, more likely to cohabitate, and had shorter LOS than those discharged to SNFs. Functional status (AM-PAC) and comorbidity burden (CCI) did not differ significantly between groups despite differences in discharge destination. In univariable models, younger age, cohabitating marital status, living with family, available assistance, shorter LOS, private insurance, and higher NIHSS were associated with greater odds of IRF discharge. In multivariable analysis, younger age (OR 0.94, 95% CI 0.91-0.98), cohabitating marital status (OR 2.46, 95% CI 1.13-5.48), and shorter LOS (OR 0.88, 95% CI 0.82-0.93) remained independently associated with IRF discharge. Conclusions: Individuals with comparable pre-stroke independence and similar clinical severity, discharge to IRF versus SNF was independently associated with non-clinical factors; age, marital status, and LOS, whereas stroke severity and functional status were not significant predictors. These findings underscore the importance of evidence-informed discharge criteria integrating clinical indicators and social context to support equitable access to intensive rehabilitation after stroke.
Hayes et al. (Tue,) studied this question.