Factors Associated with Receiving a Discharge Care Plan After Stroke in Australia: A Linked Registry Study

Abstract

Background: Discharge planning is recommended to optimise the transition from acute care to home for patients admitted with stroke. Despite this guideline recommendation, many patients do not receive a discharge care plan. Also, there is limited evidence on factors influencing the provision of discharge care plan post-stroke. We evaluated patient, clinical and system factors associated with receiving a care plan on discharge from hospital back to the community after stroke. Methods: This was an observational cohort study of patients with acute stroke who were discharged to the community between 2009–2013, using data from the Australian Stroke Clinical Registry linked to hospital administrative data. For this analysis, we used merged dataset containing information on patient demographics, clinical characteristics, and receipt of acute care processes. Multivariable logistic regression models were used to determine factors associated with receiving a discharge care plan. Results: Among 7812 eligible patients (39 hospitals, median age 73 years, 44.7% female, 56.9% ischaemic stroke), 47% received a care plan at discharge. The odds of receiving a discharge care plan increased over time (odds ratio [OR] 1.39 per year, 95% CI 1.37–1.48), and varied between hospitals. Factors associated with receiving a discharge care plan included greater socioeconomic position (OR 1.18, 95% CI 1.02–1.38), diagnosis of ischaemic stroke (OR 1.18, 95% CI 1.05–1.33), greater stroke severity (OR 1.15, 95% CI 1.01–1.31), or being discharged on antihypertensive medication (OR 3.07, 95% CI 2.69–3.50). In contrast, factors associated with a reduced odds of receiving a discharge care plan included being aged 85+ years (vs <85 years; OR 0.79, 95% CI 0.64–0.96), discharged on a weekend (OR 0.56, 95% CI 0.46–0.67), discharged to residential aged care (OR 0.48, 95% CI 0.39–0.60), or being treated in a large hospital (>300 beds; OR 0.30, 95% CI 0.10–0.92). Conclusions: Implementing practices to target people who are older, discharged to residential aged care, or discharged on a weekend may improve discharge planning and post-discharge care after stroke.