OBJECTIVE:

To examine the processes and barriers involved in providing post-discharge stroke care. DESIGN:

Prospective study of discharge planners (DPs) and physical therapists' (PTs) interpretation of factors contributing to patients' discharge destination. SETTING:

Twenty-three hospitals in the northeastern United States. PARTICIPANTS:

After exclusions, data on 427 patients hospitalized with a primary diagnosis of stroke between 05/2015 to 11/2016 were examined. 45% of patients were female; median age was 71. DPs/PTs caring for these patients were queried regarding the selection of discharge destination. INTERVENTIONS:

None. MAIN OUTCOME MEASURES:

Comparison of actual discharge destination for stroke patients to the destination(s) recommended by their DPs and PTs. RESULTS:

184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on recommended discharge destination in 355 (83.1%) cases; of these, the actual discharge destination matched the DP/PT recommended discharge destination in 92.5%. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital (when inpatient rehabilitation facility was recommended). Patient/family preference was cited by at least one respondent for discrepancy in discharge destination for 13 patients (3.1% of 355 cases); insurance barriers were cited for 9 patients (2.3% of 355 cases). CONCLUSIONS:

Most stroke survivors in the Northeast are discharged to the recommended post-acute care destination based on the consensus of DP and PT opinions. Further research is needed to guide post-acute care service selection.