Original article
Hospital Disposition After Stroke in a National Survey of Acute Cerebrovascular Diseases in Israel

https://doi.org/10.1016/j.apmr.2007.11.001Get rights and content

Abstract

Treger I, Ring H, Schwartz R, Tsabari R, Bornstein NM, Tanne D; for the National Acute Stroke Israeli Survey Group. Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel.

Objective

To investigate predictive factors for disposition after acute stroke.

Design

A nationwide survey (2004 National Acute Stroke Israeli Survey).

Setting

All 28 primary general medical centers operating in Israel.

Participants

Acute stroke patients (n=1583) admitted during February and March 2004 and discharged from the primary hospital.

Interventions

Data collected on baseline characteristics, stroke presentation, type and severity, in-hospital investigation and complications, discharge disability, acute hospital disposition, and mortality follow-up.

Main Outcome Measure

Hospital disposition to home, acute rehabilitation, or nursing facility.

Results

Among patients, 58.9% (n=932) were discharged home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) to nursing facilities. Admission neurologic status was a good predictor of hospital disposition. Patients with severe strokes were mostly discharged to rehabilitation facilities. Patients with significant functional decline before the index stroke, resulting from a previous stroke or another cause, were sent to inpatient rehabilitation less frequently. Disability level at discharge from acute hospitalization had high predictive value in hospital disposition after stroke. In the northern region of Israel, a higher proportion of patients were sent home and a lower proportion to rehabilitation and nursing facilities, probably because of lower availability of rehabilitation care in this region of Israel.

Conclusions

This nationwide survey shows that most stroke survivors in Israel are discharged home from the acute primary hospital. Good functional status before the index stroke is an important predictor for being sent to acute inpatient rehabilitation. Severity of neurologic impairment and level of disability after the stroke at discharge from the primary hospital are strong predictors for disposition after stroke in Israel. Our data may be useful in discharge planning for stroke patients by policy-makers and health care providers 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

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