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Factors Associated with Differences in the Recommended versus Actual Discharge Location After Stroke
Journal article   Open access   Peer reviewed

Factors Associated with Differences in the Recommended versus Actual Discharge Location After Stroke

Kimberly J. Waddell, Ruiqi Yan, Lin Xu, Stephen Hampton, Robert E. Burke, Rujula Upasani, Kiersten M. McCartney and M. Kit Delgado
Archives of physical medicine and rehabilitation
09 Apr 2026
DOI: https://doi.org/10.1016/j.apmr.2026.04.005
PMID: 41966298
url
https://doi.org/10.1016/j.apmr.2026.04.005View
Published, Version of Record (VoR) Open CC BY V4.0

Abstract

discharge post-acute Stroke
Objectives: Discharge planning during an acute stroke hospitalization requires a coordinated effort to ensure patients receive the most appropriate posthospital care. We identified and described discrepancies in recommended versus actual postdischarge care after stroke. Design: This retrospective cohort study used the final acute hospital discharge recommendation by physical and occupational therapy as the recommended discharge disposition. We identified those who were discharged to a different care setting than was recommended and characterized sociodemographic, clinical, and facility factors associated with this discrepancy using a multinomial logistic regression. Setting: Acute care. Participants: Individuals hospitalized for an ischemic or hemorrhagic stroke between January 1, 2018, and December 31, 2024. The cohort (N=7545) comprised stroke hospitalizations. Interventions: Not applicable. Main Outcome Measures: The recommended and actual discharge disposition. Results: The mean (SD) age was 67 (14) years, 45.2% White and 42.0% Black. Overall, 1182 (15.6%) discharges were discrepant: 950 (80.4%) went to a lower intensity care setting, and 232 (19.6%) went to a higher intensity setting. The strongest associations with a discrepant discharge were a Sunday discharge (odds ratio [OR], 1.53; 95% CI, 1.10-2.11), Medicare fee-for-service (OR, 1.43; 95% CI, 1.14-1.79), or Medicare Advantage insurance (OR, 1.34; 95% CI, 1.08-1.68), and dependent prestroke ambulation (OR, 1.38; 95% CI, 1.14-1.68). These were also the factors most associated with increased odds of discharge to a lower intensity setting. A severe stroke (OR, 0.80; 95% CI, 0.67-0.96) and physiatry consult (OR, 0.75; 95% CI, 0.64-0.89) were associated with significantly lower odds of a discrepant discharge. Hemorrhagic stroke, increased function during admission, and greater social vulnerability were associated with increased odds of discharge to a higher intensity setting. Conclusions: The factors most associated with differences in recommended versus actual postacute care were unrelated to clinical need. Addressing these underlying factors will help ensure patients receive the recommended care to maximize outcomes.

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