Abstract 151: Selection of Post-Acute Rehabilitation Facilities in the Northeast: A Survey of Discharge Planners
Introduction: The process of determining the level and type of post-acute care for stroke patients has not been adequately studied. We surveyed stroke discharge planners regarding this process, and examined the factors perceived to influence the selection of post-acute care.
Methods: Requests were sent to 471 acute care hospitals within the eight states in the Northeast Cerebrovascular Consortium (NY, NJ, MA, CT, RI, ME, VT, NH) for a discharge planner responsible for the care of stroke patients to complete an anonymous on-line survey. Respondents were asked to indicate the factors impacting the selection of post-acute care. The influence of patients/families and members of the health care team on the discharge process were rated on a 1-10 scale, and compared via a Mann-Whitney test.
Results: Experienced nurses and social workers responded (82% and 18% respectively, with 73% reporting ≥20 years healthcare experience) from 71 hospitals. Discharge planners, patients/families and physical therapists were identified as having the greatest influence in determining discharge location, with physicians rated as less influential (p<0.001). Multiple factors were perceived to influence decision planning for post-acute facility type; however, insurance was identified by 48% as the single greatest barrier in referring stroke patients to the most appropriate level of post acute care. With regard to referring patients to the most appropriate specific facility for post-acute care, the most significant barriers were insurance (27%), bed availability (18%), and facility location (8%). More than half reported “the speed with which you are able to discharge a stroke patient” impacts patients’ final destination “frequently”, “very frequently” or “always”.
Discussion: Discharge planners in this sample perceive insurance as a major barrier, and physicians to have a less influential role in determining post-acute level, type and setting for care. The pressure to discharge patients rapidly often influences the selection of post-acute care. Findings suggest non-clinical factors may disproportionately affect post-acute care decision making for stroke survivors.
Author Disclosures: A. Sicklick: None. J. Stein: Research Grant; Modest; PCORI. Other Research Support; Modest; Tyromotion, Myomo. Speakers' Bureau; Modest; QuantiaMD. Consultant/Advisory Board; Modest; Northeast Cerebrovascular Consoritum (Chair unpaid), Myomo (unpaid). R. Hedeman: None. J. Prvu-Bettger: Research Grant; Significant; AHRQ, PCORI. Z. Magdon-Ismail: None. L. Martin: None.
- © 2014 by American Heart Association, Inc.