Different rehabilitation destinations: non-clinical factors associated with inpatient rehabilitation versus skilled nursing placement

Purpose Examine clinical and non-clinical factors associated with post-acute rehabilitation placement after acute ischemic stroke. Methods 236 adults hospitalized with acute ischemic stroke; independent and community-dwelling before stroke; and discharged to an inpatient rehabilitation facility (IRF; n = 171) or skilled nursing facility (SNF; n = 65). Clinical factors included NIHSS, Charlson Comorbidity Index (CCI), length of stay (LOS), AM-PAC “6-Clicks,” and neglect. Non-clinical factors included demographics and contextual characteristics. Logistic regression was used for associations with discharge location. Results Individuals discharged to IRFs were younger, more likely to cohabitate, and had shorter LOS. Functional status (AM-PAC) and CCI did not differ significantly between groups despite differences in discharge destination. In univariable analyses, 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 the multivariable analysis, increasing age (OR 0.95, 95% CI 0.91–0.98) and greater comorbidity burden (CCI: OR 0.85, 95% CI 0.73–0.98) were associated with lower odds of IRF discharge. Marital status was not associated with discharge destination after adjustment. Conclusions Among previously independent stroke survivors, discharged to an IRF or SNF increasing age and greater comorbidity burden were associated with lower odds of IRF placement after adjustment. NIHSS and AM-PAC Daily Activities scores were not associated with placement in the adjusted analysis.