Stroke: Stroke patients, how do they recover after being discharged from the hospital?

In the United States, 800,000 people are affected by stroke each year
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Given that two-thirds of stroke patients require rehabilitation services, post-acute care plays a key role in the recovery of patients

Compared with most SNFs, IRF usually provides more intensive rehabilitation, nursing, and doctor care
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However, the cost of IRF is relatively high, and some stroke survivors cannot participate in or benefit from this level of rehabilitation, or can be satisfactorily recovered in any facility

However, the standard for determining the level of care after the acute phase is still subjective, and the application is also inconsistent.
There is overlap in which patients are diverted to IRF or SNF
.

The lack of an effective decision support tool to make decisions about post-acute care has led to differences in practice

Some studies have classified items that affect the destination of care after the acute phase (for example, mobility status, cognitive function, previous living environment, functional dependence/disease, demographic factors)
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Other studies have explored the use of standardized assessments, which are measures of stroke severity, activities of daily living, activity, and cognitive ability, to determine which factors best predict the level of care after the acute phase

Stroke

Joel Stein and others of Columbia University used the Delphi method to obtain expert consensus on the factors that affect the choice of post-acute care levels
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The Delphi method is a structured and iterative process, in the absence of a gold standard, a consensus is reached through a panel of experts

consensus

They used 4 rounds of Delphi cooperation process to obtain a refined list of factors that influence the choice of the level of care after the acute period
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The Delphi expert team consists of 32 team members, including doctors, physiotherapists, occupational therapists, speech pathologists, nurses, stroke survivors, administrators, policy experts and individuals related to third-party insurance companies

In the first round, 207 factors were proposed.
After discussion, they were combined into 15 factors for consideration
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In the second round, 15 factors were ranked and a consensus was reached on 10 factors;

In the third round, 10 factors were ranked and a consensus was reached on 9 factors
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In the fourth and final round, 9 factors are rated, with Likert scores ranging from 5 (most important) to 1 (not important)

The probability of benefiting from an active rehabilitation plan (97%), requires clinicians with professional rehabilitation skills (94%), requires active and continuous medical management and monitoring (84%), and the ability to tolerate active rehabilitation plans (74%) %), need caregiver training to return to the community (48%), family/caregiver support (39%), possibility of returning to the community/family (39%), ability to return to the actual home environment (32%), and illness Former dementia (16%)
.

manage

The significance of this study provides a set of key factors based on expert consensus that need to be considered when determining the location of care for stroke patients after discharge
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These factors may be helpful in the development of decision support tools for clinical use
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The significance of this study provides a set of key factors based on expert consensus, which need to be considered when determining the location of post-discharge care for stroke patients

Original source:
Stein J, Rodstein BM, Levine SR, et al.
Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study.
Stroke.
Published online October 28, 2021:STROKEAHA.
121.
034815.
doi:10.
1161/STROKEAHA .
121.
034815

Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study.
Stroke.

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