Logo image
Back
Factors associated with discharge to skilled nursing despite a clinical recommendation for inpatient rehabilitation
Journal article   Open access   Peer reviewed

Factors associated with discharge to skilled nursing despite a clinical recommendation for inpatient rehabilitation

Kiersten M. McCartney, Ruiqi Yan, Lin Xu, Rujula Upasani, Stephen Hampton, Robert E. Burke, M. Kit Delgado and Kimberly J. Waddell
Journal of stroke and cerebrovascular diseases, v 35(6), 108653
01 Jun 2026
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108653
PMID: 42070673
url
https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108653View
Published, Version of Record (VoR) Open CC BY-NC-ND V4.0

Abstract

Discharge Inpatient rehabilitation Post-acute Skilled nursing Stroke
• Two-thirds of adults with stroke will receive post-acute rehabilitation. • Recommended post-acute discharge setting may not match the actual discharge location. • 10% of patients recommended for inpatient rehab actually discharge to skilled nursing. • A discharge to skilled nursing driven a combination of clinical and non-clinical factors. • Discharge to this lower intensity setting could impact long-term stroke recovery. Two-thirds of adults with stroke receive post-acute rehabilitation to enhance recovery. For many, higher-intensity, but more costly, rehabilitation at an inpatient rehabilitation facility (IRF) is associated with improved outcomes compared to a skilled nursing facility (SNF). Little is known on how often patients recommended for IRF discharge actually discharge to SNF. Ensuring patients receive post-acute care that aligns with clinical need is crucial for long-term outcomes. This study examined how often patients recommended for an IRF discharge after stroke hospitalization discharge to a SNF, and examined the factors associated with this discrepant discharge. Retrospective cohort study of adults hospitalized for stroke in a multi-hospital health system between January 1, 2018 – December 31, 2024. Electronic health record data identified physical and occupational therapy recommendations for an IRF discharge and the post-discharge location (IRF or SNF). A generalized logistic regression examined factors associated with SNF discharge. Among 3388 stroke hospitalizations which recommended IRF, 3092 (91%) discharged to IRF and 296 (9%) discharged to SNF. Enrollment in Medicare Advantage (OR=2.80, 95%CI [1.68, 4.68]), traditional Medicare (OR=2.05, 95%CI [1.22, 3.43]), age ≥ 85 years (OR=1.98, 95%CI [1.17, 3.37]), dependent pre-admission mobility (OR=1.81, 95%CI [1.21, 2.70]), and acute hospital length of stay (OR=1.03, 95%CI=[1.02, 1.04] were most strongly associated with a discrepant discharge. Among those recommended for IRF discharge, a SNF discharge was driven by a combination of both clinical and non-clinical factors. These results underscore the need to consider how both clinical and non-clinical factors influence this process and may impact long-term outcomes.

Metrics

1 Record Views

Details

Logo image