Abstract 21: Patient and Hospital Characteristics Associated with Assessment for Rehabilitation During Hospitalization for Acute Ischemic Stroke
Introduction: Delays in post-stroke rehabilitation can negatively affect functional recovery and health-care costs. While clinical guidelines recommend that all stroke patients receive a standardized assessment during the acute hospitalization, the degree and determinants of acute assessment for rehabilitation (AAR) following ischemic stroke are unknown.
Methods: We analyzed data from 1540 Get With The Guidelines-Stroke hospitals from 01/08/2008 to 03/31/2011. Patients who died in hospital, left AMA, or were transferred in from or out to another acute hospital were excluded. Univariate (chi-square or Wilcoxon as appropriate) and multivariable logistic regression analyses with GEE were used to identify factors independently associated with an AAR while accounting for within hospital clustering.
Results: Among 616,982 ischemic stroke patients, 89.5% had an AAR documented. Those without AAR were more likely white, older, female, unable to ambulate prior to admission, from a chronic care facility, have Medicare health insurance and comorbid conditions. Also without an AAR were those with moderate-severe stroke (NIHSS≥6), unable to ambulate on day 2, and were not cared for in a stroke unit. Nine percent of patients discharged home without services were not assessed for rehabilitation. In multivariable analysis, many factors were independently associated with receiving an AAR; however, patients with the greatest odds (OR>1.2) were of Black race, without a history of carotid stenosis, ambulating independently prior to admission, had stroke symptoms outside of a healthcare facility, were treated at a Northeast hospital, in a stroke unit, had complications from thrombolytic therapy, and were ambulating on hospital day 2 (Table).
Conclusion: Although 90% of ischemic stroke patients received an AAR, the results suggest important subpopulations were overlooked. Quality improvement efforts are needed to ensure that all stroke patients are assessed and referred for the appropriate level of rehabilitation care for their needs. Further research of the unexplained variation in AAR is warranted.
- © 2012 by American Heart Association, Inc.