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Out of sight, out of mind: long-term outcomes for people discharged home, to inpatient rehabilitation and to residential aged care after stroke

journal contribution
posted on 12.01.2021, 05:32 authored by EA Lynch, AS Labberton, J Kim, MF Kilkenny, NE Andrew, Natasha LanninNatasha Lannin, R Grimley, SG Faux, DA Cadilhac

Purpose: The aim of this study was to describe differences in long-term outcomes for patients discharged to inpatient rehabilitation facilities (IRFs) following stroke compared to patients discharged directly home or to residential aged care facilities (RACFs). Materials and methods: Cohort study. Data from the Australian Stroke Clinical Registry were linked to hospital admissions records and the national death index. Main outcomes: death and hospital readmissions up to 12 months post-admission, Health-related Quality of Life (HRQoL) 90-180 days post-admission. Results: Of 8,555 included patients (median age 75, 55% male, 83% ischemic stroke), 4,405 (51.5%) were discharged home, 3,442 (40.2%) to IRFs, and 708 (8.3%) to RACFs. No between-group differences were observed in hazard of death between patients discharged to IRFs versus home. Fewer patients discharged to IRFs were readmitted to hospital within 90, 180 or 365-days compared to patients discharged home (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61; aSHR:180-days 0.74, 95%CI 0.67, 0.82; aSHR:365-days 0.85, 95%CI 0.78, 0.93). Fewer patients discharged to IRFs reported problems with mobility compared to those discharged home (adjusted OR 0.54, 95%CI 0.47, 0.63), or to RACFs (aOR 0.35, 95%CI 0.25, 0.48). Overall HRQoL between 90-180 days was worse for people discharged to IRFs versus those discharged home and better than those discharged to RACFs. Conclusions: Several long-term outcomes differed significantly for patients discharged to different settings after stroke. Patients discharged to IRFs reported some better outcomes than people discharge directly home despite having markers of more severe stroke.Implications for rehabilitation People with mild strokes are usually discharged directly home, people with moderate severity strokes to inpatient rehabilitation, and people with very severe strokes are usually discharged to residential aged care facilities. People discharged to inpatient rehabilitation reported fewer problems with mobility and had a reduced risk of hospital readmission in the first year post-stroke compared to people discharged directly home after stroke. The median self-reported health-related quality of life for people discharged to residential aged care equated to ‘worst health state imaginable’.

Funding

The AuSCR was supported by grants from the National Health and Medical Research Council (NHMRC) [grant number 1034415] and Monash University, Queensland Health, Victorian Department of Health and Human Services, the Stroke Foundation, Allergan Australia, Ipsen, Boehringer Ingelheim, and consumer donations. The following authors receive Research Fellowship support from the NHMRC: Author 1 [grant number 1138515]; Author 4 [grant number 1109426]; Author 5 [grant number 1072053]; Author 9 [grant number 1063761], [grant number 1154273], and Heart Foundation (Australia): Author 6 [grant number 102055].

History

Publication Date

01/06/2022

Journal

Disability and Rehabilitation

Volume

44

Issue

12

Pagination

7p. (p.2608-2014)

Publisher

Taylor & Francis

ISSN

0963-8288

Rights Statement

© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.