Predictors of discharge destination of stroke patients from inpatient rehabilitation center, including difficult discharge cases

Abstract

Abstract Background After finishing a stroke rehabilitation program, patients’ discharge destinations as well as the incidence of delayed discharge can substantially influence both patient care and the efficiency of the healthcare system. Identifying early predictors of these outcomes may improve discharge planning and better utilization of rehabilitation resources. Methods The study included 226 stroke patients who received an inpatient rehabilitation program. Data were collected retrospectively from patients’ records, including stroke severity, which was measured by national institute of health stroke scale (NIHSS); functional status using functional independence measure (FIM); and cognitive function, using the Montreal cognitive assessment (MoCA). Results Most patients were discharged home (85%), while 10% were discharged to long-term care (LTC) and 5% to acute care facilities. Higher admission FIM and MoCA scores were significantly associated with home discharge. Older age, lower functional and cognitive scores, multiple comorbidities, and hemorrhagic stroke were associated with LTC placement and delayed discharge. Multivariable analysis identified admission FIM score, MoCA score, and stroke type as independent predictors of LTC placement. Delayed discharge occurred in 27.4% of patients and was significantly associated with poorer functional and cognitive performance and inadequate family support. Conclusion Early functional and cognitive assessment utilizing FIM and MoCA can facilitate the prediction of discharge destination and the identification of patients at risk for delayed discharge. Incorporating family-centered discharge planning may improve discharge efficiency and reduce reliance on institutional care.