Original articleHospital Disposition After Stroke in a National Survey of Acute Cerebrovascular Diseases in Israel
Section snippets
Methods
This study is based on a national survey of all consecutive hospitalized patients with acute cerebrovascular disease hospitalized in all Israel’s medical centers during February and March 2004, known as the National Acute Stroke Israeli Survey−2004 (NASIS). The study methodology has been described previously.14 Similar surveys for a 2-month period are planned every 3 years in order to assess trends over time, while reducing costs compared with an ongoing national registry. In brief, the study
Results
During the survey period 1583 patients admitted to a general hospital were diagnosed as suffering from a cerebrovascular event.
Most of the patients (58.9% [n=932]) were discharged to their home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) were discharged to nursing facilities. Patients discharged to nursing facilities were on average older (age, 80.1±9.2y) than those discharged to rehabilitation (age, 72.4±11.5y), or home (age, 69.0±12.5y). Adjusting for differences in
Discussion
Consistent with previous studies,20 our national survey showed that most patients after acute hospitalization were sent to their home. Based on the World Health Organization, the life expectancy in Israel is 78 years for men and 82 years for women as compared with 75 years for men and 80 years for women in the United States. The health life expectancy is 70 years for men and 72 years for women in Israel and 67 years and 71 years respectively in the United States. It was shown in a recent study
Conclusions
Our national survey found that most stroke survivors in Israel are discharged home from the acute primary hospital. Patient’s good functional status before the index stroke is an important predictor for being discharged to acute inpatient rehabilitation. The severity of neurologic impairment and the level of disability after stroke and at discharge from primary hospital are strong predictors for disposition after stroke in Israel. Also different clinical parameters and complications were found
Acknowledgments
Principal investigators of the National Acute Stroke Israeli Survey (NASIS) group were: D. Tanne, MD, and N.M. Bornstein, MD. Executive committee members were: D. Tanne, MD, U. Goldbourt, PhD, S. Koton, PhD, E. Grossman, MD, N. Koren-Morag, PhD, M.S. Green, MD, PhD, and N.M. Bornstein, MD. Data management was centered at the Israeli Society for the Prevention of Heart Attacks, under the oversight of S. Behar, MD, A. Sandach, MSc, R. Schwartz, BSc, and M. Benderly, PhD. Quality assurance and
References (35)
- et al.
Functional measures of first stroke in-patient rehabilitation: the use of the FIM total score with a clinical rationale
Arch Phys Med Rehabil
(1997) Heart disease and stroke statistics—2004 update
(2003)- et al.
Care of patients with cerebral stroke in general hospitals in Israel: the perspective of professionals
(1999) - et al.
Management of adult stroke rehabilitation care: a clinical practice guideline
Stroke
(2005) - et al.
Prediction of hospital disposition after thrombolysis for acute ischemic stroke using the National Institutes of Health stroke scale
Arch Neurol
(2004) - et al.
Disposition after acute stroke: who is not sent home from hospital?
Neuroepidemiology
(1998) - et al.
Cost-effectiveness of integrated stroke services
QJM
(2005) - et al.
Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: I: health outcomes at 6 months
Stroke
(2000) - et al.
Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: II: cost minimization analysis at 6 months
Stroke
(2000) - et al.
Allocation and preference of patients for domiciliary or institutional rehabilitation after a stroke
Int J Rehabil Res
(2004)
Utility of the NIH stroke scale as a predictor of hospital disposition
Stroke
Predictors of resource use after acute hospitalizationThe Northern Manhattan Stroke Study
Neurology
Recovery rates after stroke and their impact on outcome prediction
Neurorehabil Neural Repair
Criteria for referral of CVA patients to rehabilitation
Scand J Rehabil Med Suppl
A national survey of acute cerebrovascular disease in Israel: burden, management, outcome and adherence to guidelines
Isr Med Assoc J
Measurements of acute cerebral infarction: a clinical examination scale
Stroke
Comparison of neurological scales and scoring systems for acute stroke prognosis
Stroke
Cited by (16)
IScore for predicting institutional care after ischemic stroke: A population-based study
2015, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Recent improvements in the management of acute ischemic stroke have led to increasing the number of patients who survive after the event, especially, elderly people because of the progressive aging population. Among stroke survivors, 45%-75% are unable to return home at once and need to be discharged to either a rehabilitation facility or a nursing home, with consequences in terms of both quality of life and economic costs for the society.1-7 From a health care organization point of view, better identifying the need for poststroke institutional care is a difficult but great challenge so as to adjust necessary resources in terms of number of beds and health care professionals, to estimate costs, and to make projection on future needs.
Selection for inpatient rehabilitation after acute stroke: A systematic review of the literature
2011, Archives of Physical Medicine and RehabilitationCitation Excerpt :In the studies that looked at age in relation to discharge to rehabilitation, those discharged to rehabilitation tended to be older than those discharged home and younger than those discharged to supported accommodation. The National Institutes of Health Stroke Scale (NIHSS) was used in 543,60,83,84,87 of the 7 studies measuring stroke severity, including 1 study of high quality comparing the Wake Forest Stroke Severity Scale and the NIHSS.60 The Mini-Mental State Examination was used in 2 of the 4 studies assessing poststroke cognition55,65; the other 2 studies measuring cognition used scales that had not previously been validated.63,78
Predicting Discharge to Institutional Long-Term Care After Stroke: A Systematic Review and Metaanalysis
2018, Journal of the American Geriatrics Society
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.