Decline in Rehab Transfers Among Rehab-Eligible Stroke Patients During the COVID-19 Pandemic
To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic. We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acu...
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| Veröffentlicht in: | Journal of stroke and cerebrovascular diseases 2021-08, Vol.30 (8), p.105857-105857, Article 105857 |
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| creator | Thau, Lauren Siegal, Taylor Heslin, Mark E. Rana, Ameena Yu, Siyuan Kamen, Scott Chen, Austin Vigilante, Nicholas Gallagher, Sheri Wegner, Kevin Thon, Jesse M. Then, Ryna Patel, Pratit Yeager, Terri Jovin, Tudor G. Kumar, Rohini J. Owens, David E. Siegler, James E. |
| description | To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic.
We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression.
Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2021.105857 |
| format | Article |
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We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression.
Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p<0.001) despite a significant increase in discharge disability (median discharge mRS 4 [IQR 2-4] vs. 2 [IQR 1-3], p<0.001) during the pandemic.
Admission for stroke during the COVID-19 pandemic was associated with a significantly lower probability of being discharged to an IRF. This effect persisted despite adjustment for predictors of IRF disposition, including functional disability at discharge. Potential reasons for this disparity are explored.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2021.105857</identifier><identifier>PMID: 34022581</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; COVID-19 ; Disability Evaluation ; Female ; Humans ; Ischemic stroke ; Male ; Middle Aged ; New Jersey ; Patient Discharge - trends ; Patient Transfer - trends ; Practice Patterns, Physicians' - trends ; Recovery of Function ; Registries ; Rehabilitation ; Retrospective Studies ; Stroke - diagnosis ; Stroke - physiopathology ; Stroke - therapy ; Stroke Rehabilitation - trends ; Time Factors</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2021-08, Vol.30 (8), p.105857-105857, Article 105857</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021 Elsevier Inc. All rights reserved. 2021 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-4ba9820e7033c26b4887b2f4927321ab0c912d75ae4135820250f4dc04eca3443</citedby><cites>FETCH-LOGICAL-c519t-4ba9820e7033c26b4887b2f4927321ab0c912d75ae4135820250f4dc04eca3443</cites><orcidid>0000-0003-0540-4816 ; 0000-0001-9098-9139 ; 0000-0003-4217-4984 ; 0000-0002-4619-4440 ; 0000-0001-5107-2651 ; 0000-0002-7895-7780 ; 0000-0003-0287-3967 ; 0000-0002-0896-9540</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1052305721002603$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34022581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thau, Lauren</creatorcontrib><creatorcontrib>Siegal, Taylor</creatorcontrib><creatorcontrib>Heslin, Mark E.</creatorcontrib><creatorcontrib>Rana, Ameena</creatorcontrib><creatorcontrib>Yu, Siyuan</creatorcontrib><creatorcontrib>Kamen, Scott</creatorcontrib><creatorcontrib>Chen, Austin</creatorcontrib><creatorcontrib>Vigilante, Nicholas</creatorcontrib><creatorcontrib>Gallagher, Sheri</creatorcontrib><creatorcontrib>Wegner, Kevin</creatorcontrib><creatorcontrib>Thon, Jesse M.</creatorcontrib><creatorcontrib>Then, Ryna</creatorcontrib><creatorcontrib>Patel, Pratit</creatorcontrib><creatorcontrib>Yeager, Terri</creatorcontrib><creatorcontrib>Jovin, Tudor G.</creatorcontrib><creatorcontrib>Kumar, Rohini J.</creatorcontrib><creatorcontrib>Owens, David E.</creatorcontrib><creatorcontrib>Siegler, James E.</creatorcontrib><title>Decline in Rehab Transfers Among Rehab-Eligible Stroke Patients During the COVID-19 Pandemic</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic.
We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression.
Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p<0.001) despite a significant increase in discharge disability (median discharge mRS 4 [IQR 2-4] vs. 2 [IQR 1-3], p<0.001) during the pandemic.
Admission for stroke during the COVID-19 pandemic was associated with a significantly lower probability of being discharged to an IRF. This effect persisted despite adjustment for predictors of IRF disposition, including functional disability at discharge. Potential reasons for this disparity are explored.</description><subject>Aged</subject><subject>COVID-19</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic stroke</subject><subject>Male</subject><subject>Middle Aged</subject><subject>New Jersey</subject><subject>Patient Discharge - trends</subject><subject>Patient Transfer - trends</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Recovery of Function</subject><subject>Registries</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Stroke - diagnosis</subject><subject>Stroke - physiopathology</subject><subject>Stroke - therapy</subject><subject>Stroke Rehabilitation - trends</subject><subject>Time Factors</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkd1L5DAUxcOi-DHrv7D0UYSOufmYti-CzvgFAy67rk9CSNPbmYxt4yadgf3vjVsVBV98uiH3x7mHcwg5AjoGCpPj1XgVeu8e0KDH0ruNDpUNY0YZREDmMvtG9kByluYSYCu-qWQppzLbJfshrCgFiNQO2eWCMiZz2CP3MzSN7TCxXfILl7pMbr3uQo0-JKet6xbDb3re2IUtG0x-_3eQ_NS9xa4PyWztbaT6JSbTm7vrWQpFXHYVttZ8J9u1bgIevMwR-XNxfju9Suc3l9fT03lqJBR9Kkpd5IxiRjk3bFKKPM9KVouCZZyBLqkpgFWZ1CiAy0gySWtRGSrQaC4EH5GTQfdxXbZYmWjM60Y9ettq_085bdXHTWeXauE2Ks8mhZxAFDh8EfDu7xpDr1obDDaN7tCtg2KSQwwsi3NEzgbUeBeCx_rtDFD1XJNaqc9qUs81qaGmKPLjveE3iddeIjAfAIyxbSx6FUzM22BlPZpeVc5-5d4T3s6xZw</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Thau, Lauren</creator><creator>Siegal, Taylor</creator><creator>Heslin, Mark E.</creator><creator>Rana, Ameena</creator><creator>Yu, Siyuan</creator><creator>Kamen, Scott</creator><creator>Chen, Austin</creator><creator>Vigilante, Nicholas</creator><creator>Gallagher, Sheri</creator><creator>Wegner, Kevin</creator><creator>Thon, Jesse M.</creator><creator>Then, Ryna</creator><creator>Patel, Pratit</creator><creator>Yeager, Terri</creator><creator>Jovin, Tudor G.</creator><creator>Kumar, Rohini J.</creator><creator>Owens, David E.</creator><creator>Siegler, James E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0540-4816</orcidid><orcidid>https://orcid.org/0000-0001-9098-9139</orcidid><orcidid>https://orcid.org/0000-0003-4217-4984</orcidid><orcidid>https://orcid.org/0000-0002-4619-4440</orcidid><orcidid>https://orcid.org/0000-0001-5107-2651</orcidid><orcidid>https://orcid.org/0000-0002-7895-7780</orcidid><orcidid>https://orcid.org/0000-0003-0287-3967</orcidid><orcidid>https://orcid.org/0000-0002-0896-9540</orcidid></search><sort><creationdate>20210801</creationdate><title>Decline in Rehab Transfers Among Rehab-Eligible Stroke Patients During the COVID-19 Pandemic</title><author>Thau, Lauren ; Siegal, Taylor ; Heslin, Mark E. ; Rana, Ameena ; Yu, Siyuan ; Kamen, Scott ; Chen, Austin ; Vigilante, Nicholas ; Gallagher, Sheri ; Wegner, Kevin ; Thon, Jesse M. ; Then, Ryna ; Patel, Pratit ; Yeager, Terri ; Jovin, Tudor G. ; Kumar, Rohini J. ; Owens, David E. ; Siegler, James E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-4ba9820e7033c26b4887b2f4927321ab0c912d75ae4135820250f4dc04eca3443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>COVID-19</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemic stroke</topic><topic>Male</topic><topic>Middle Aged</topic><topic>New Jersey</topic><topic>Patient Discharge - trends</topic><topic>Patient Transfer - trends</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Recovery of Function</topic><topic>Registries</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Stroke - diagnosis</topic><topic>Stroke - physiopathology</topic><topic>Stroke - therapy</topic><topic>Stroke Rehabilitation - trends</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thau, Lauren</creatorcontrib><creatorcontrib>Siegal, Taylor</creatorcontrib><creatorcontrib>Heslin, Mark E.</creatorcontrib><creatorcontrib>Rana, Ameena</creatorcontrib><creatorcontrib>Yu, Siyuan</creatorcontrib><creatorcontrib>Kamen, Scott</creatorcontrib><creatorcontrib>Chen, Austin</creatorcontrib><creatorcontrib>Vigilante, Nicholas</creatorcontrib><creatorcontrib>Gallagher, Sheri</creatorcontrib><creatorcontrib>Wegner, Kevin</creatorcontrib><creatorcontrib>Thon, Jesse M.</creatorcontrib><creatorcontrib>Then, Ryna</creatorcontrib><creatorcontrib>Patel, Pratit</creatorcontrib><creatorcontrib>Yeager, Terri</creatorcontrib><creatorcontrib>Jovin, Tudor G.</creatorcontrib><creatorcontrib>Kumar, Rohini J.</creatorcontrib><creatorcontrib>Owens, David E.</creatorcontrib><creatorcontrib>Siegler, James E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thau, Lauren</au><au>Siegal, Taylor</au><au>Heslin, Mark E.</au><au>Rana, Ameena</au><au>Yu, Siyuan</au><au>Kamen, Scott</au><au>Chen, Austin</au><au>Vigilante, Nicholas</au><au>Gallagher, Sheri</au><au>Wegner, Kevin</au><au>Thon, Jesse M.</au><au>Then, Ryna</au><au>Patel, Pratit</au><au>Yeager, Terri</au><au>Jovin, Tudor G.</au><au>Kumar, Rohini J.</au><au>Owens, David E.</au><au>Siegler, James E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Decline in Rehab Transfers Among Rehab-Eligible Stroke Patients During the COVID-19 Pandemic</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>30</volume><issue>8</issue><spage>105857</spage><epage>105857</epage><pages>105857-105857</pages><artnum>105857</artnum><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic.
We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression.
Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p<0.001) despite a significant increase in discharge disability (median discharge mRS 4 [IQR 2-4] vs. 2 [IQR 1-3], p<0.001) during the pandemic.
Admission for stroke during the COVID-19 pandemic was associated with a significantly lower probability of being discharged to an IRF. This effect persisted despite adjustment for predictors of IRF disposition, including functional disability at discharge. Potential reasons for this disparity are explored.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34022581</pmid><doi>10.1016/j.jstrokecerebrovasdis.2021.105857</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-0540-4816</orcidid><orcidid>https://orcid.org/0000-0001-9098-9139</orcidid><orcidid>https://orcid.org/0000-0003-4217-4984</orcidid><orcidid>https://orcid.org/0000-0002-4619-4440</orcidid><orcidid>https://orcid.org/0000-0001-5107-2651</orcidid><orcidid>https://orcid.org/0000-0002-7895-7780</orcidid><orcidid>https://orcid.org/0000-0003-0287-3967</orcidid><orcidid>https://orcid.org/0000-0002-0896-9540</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of stroke and cerebrovascular diseases, 2021-08, Vol.30 (8), p.105857-105857, Article 105857 |
| issn | 1052-3057 1532-8511 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged COVID-19 Disability Evaluation Female Humans Ischemic stroke Male Middle Aged New Jersey Patient Discharge - trends Patient Transfer - trends Practice Patterns, Physicians' - trends Recovery of Function Registries Rehabilitation Retrospective Studies Stroke - diagnosis Stroke - physiopathology Stroke - therapy Stroke Rehabilitation - trends Time Factors |
| title | Decline in Rehab Transfers Among Rehab-Eligible Stroke Patients During the COVID-19 Pandemic |
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