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Predictors of resource use after acute hospitalization

The Northern Manhattan Stroke Study

From the Department of Neurology (Drs. Rundek, Mast, Hartmann, Lennihan, Lin, Paik, B. Boden–Albala, and Sacco) and the Sergievsky Center, Divisions of Epidemiology (Dr. Sacco), Socio-Medical Science (B. Boden–Albala), and Biostatistics (Drs. Lin and Paik), Columbia University College of Physicians and Surgeons and School of Public Health, New York; the Helen Hayes Hospital (Dr. Lennihan), West Haverstraw, NY; and the Klinik für Neurologie (Dr. Mast), Schlaganfallzentrum Halle, Stroke Unit, Berufsgenossenschaftliche Kliniken der Stadt Halle, Bergmannstrost, Germany.

Address correspondence and reprint requests to Dr. Tanja Rundek, Neurological Institute, Room 552, 710 West 168th Street, New York, NY 10032; e-mail: tr89{at}columbia.edu

OBJECTIVE: To determine demographic and clinical predictors of discharge destinations following acute care hospitalization for stroke in the community of northern Manhattan.

METHODS: A group of 893 patients (mean age, 70 ± 12 years; 56% women; 51% Hispanic, 30% African-American, 19% white) who survived acute care hospitalization for a first ischemic stroke were followed prospectively. Stroke severity was assessed by the NIH Stroke Scale and categorized as mild (5), moderate (6 to 13), and severe (14). Polytomous logistic regression was used to determine predictors for rehabilitation and nursing home placement versus returning home.

RESULTS: Among the survivors of acute stroke care hospitalization, 611 (68%) patients were discharged to their homes, 168 (19%) to rehabilitation, and 114 (13%) to nursing homes. Patients with moderate and severe neurologic deficits had more than a threefold increased risk of being sent to a nursing home and more than an eightfold increased risk of being sent to rehabilitation. Age over 65 and cognitive impairment were associated with placement to a nursing home (age over 65: OR, 2.4; 95% CI, 1.0 to 5.6; cognitive impairment: OR, 2.9; 95%, CI 1.4 to 5.7), and rehabilitation (age over 65: OR, 1.8; 95% CI, 1.1 to 2.9; cognitive impairment: OR, 2.9; 95% CI, 1.4 to 5.7).

CONCLUSION: Our results demonstrated that one-third of patients with acute stroke from the community of northern Manhattan required placement in a temporary or a long-term disability care institution following acute care hospitalization. Severity of stroke is an important factor that influences discharge planning following acute care hospitalization and its reduction can improve health care resource usage.

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