Discharge disposition following acute ischemic stroke in the veterans health administration: A retrospective cohort study

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-22 DOI:10.1016/j.jstrokecerebrovasdis.2025.108435

Kimberly J. Waddell PhD, MSCI , Anthony J. Perkins MS , Laura J. Myers PhD , Joanne K. Daggy PhD , Qinglan Ding PhD , Ali Sexson MBA , Stanley E. Taylor MA , Jason J. Sico MD , Dawn M. Bravata MD

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引用次数: 0

Abstract

Background

The purpose of this study was to examine the discharge disposition of older adults who were hospitalized for an ischemic stroke in the Veterans Health Administration (VA).

Methods

This retrospective cohort evaluation included Veterans, admitted to one of 36 distinct medical centers, who discharged from the acute hospital to home, home with home health services, an inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). Unadjusted trends in the proportion of discharges to each setting by year was examined using the Cochrane-Armitage test for trend. The association of demographic, clinical, and facility characteristics with discharge disposition were examined using a multinomial logistic regression.

Results

The cohort comprised 4,623 older Veterans with a mean (SD) age 75.3 (7.3) years; 72.9% went home, 6.6% discharged to an IRF, and 20.5% discharged to a SNF. There was a significant change in the proportion of patients discharged to a SNF (2019, 24.5%; 2020, 18.7%; and 2021, 19.8%, P = 0.007). Multiple clinical factors were consistently associated with discharge to SNF versus home, IRF versus home, and IRF versus SNF. Age 85 or older was significantly associated with higher odds of discharge to SNF versus home (OR 1.37, 95% CI [1.03, 1.80], P =0.02), and lower odds of discharge to an IRF versus SNF (OR 0.58, 95% CI0.35, 0.95], P=0.03).

Conclusions

The clinical presentation of individuals hospitalized for acute ischemic stroke was most strongly and consistently associated with discharge location. Demographic and facility variables were sparsely associated with discharge disposition across all settings.

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退伍军人健康管理部门急性缺血性中风后的出院处置：一项回顾性队列研究

背景：本研究的目的是研究在退伍军人健康管理局（VA）因缺血性中风住院的老年人的出院处理。方法本回顾性队列评价纳入了36个不同医疗中心之一的退伍军人，他们从急性医院出院到家庭、家庭保健服务、住院康复机构（IRF）或熟练护理机构（SNF）。使用Cochrane-Armitage趋势检验，对每年各设置的出院比例进行未经调整的趋势检验。人口统计学、临床和设施特征与出院处置的关系使用多项逻辑回归进行了检验。结果该队列包括4623名老年退伍军人，平均（SD）年龄为75.3（7.3）岁；72.9%的人回家，6.6%的人转到IRF， 20.5%的人转到SNF。出院至SNF的患者比例发生显著变化（2019年，24.5%；2020年，18.7%；2021年，19.8%,P = 0.007）。多个临床因素一致地与SNF出院与家庭、IRF出院与家庭、IRF出院与SNF出院相关。年龄在85岁或以上的患者因SNF出院的几率比在家高（or 1.37, 95% CI [1.03, 1.80]， P= 0.02），因IRF出院的几率比SNF低（or 0.58, 95% CI0.35, 0.95]， P=0.03）。结论急性缺血性脑卒中患者的临床表现与出院部位的关系最为密切。人口统计和设施变量与所有设置的出院处置稀疏相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.