Hospital discharge disposition of stroke patients in Tennessee

Jin S. Cho, Zhen Hu, Nancy Fell, Gregory Heath, Rehan Qayyum, Mina Sartipi

Research output: Contribution to journalArticle

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Abstract

Objectives: Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with hospital discharge disposition status and predict such status at the time of an acute stroke admission. Methods: We analyzed 127,581 records of patients with stroke hospitalized between 2010 and 2014. Logistic regression was used to generate odds ratios with 95% confidence intervals to examine the factor outcome association. An easy-to-use clinical predictive tool was built by using integer-based risk scores derived from coefficients of multivariable logistic regression. Results: Among the 127,581 records of patients with stroke, 86,114 (67.5%) indicated home discharge and 41,467 (32.5%) corresponded to facility discharge. All considered patient characteristics had significant correlations with hospital discharge disposition status. Patients were at greater odds of being discharged to another facility if they werewomen; older; black; patients with a subarachnoid or intracerebral hemorrhage; those with the comorbidities of diabetes mellitus, heart disease, hypertension, chronic kidney disease, arrhythmia, or depression; those transferred from another hospital; or patients with Medicare as the primary payer. A predictive tool had a discriminatory capability with area under the curve estimates of 0.737 and 0.724 for derivation and validation cohorts, respectively. Conclusions: Our investigation revealed that the hospital discharge disposition pattern of patients with stroke in Tennessee was associated with the key patient characteristics of selected demographics, clinical indicators, and insurance status. These analyses resulted in the development of an easy-to-use predictive tool for early determination of hospital discharge disposition status.

Original languageEnglish (US)
Pages (from-to)594-600
Number of pages7
JournalSouthern medical journal
Volume110
Issue number9
DOIs
StatePublished - Sep 1 2017

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Stroke
Logistic Models
Insurance Coverage
Patient Discharge
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Medicare
Chronic Renal Insufficiency
Area Under Curve
Comorbidity
Cardiac Arrhythmias
Heart Diseases
Diabetes Mellitus
Odds Ratio
Demography
Confidence Intervals
Hypertension

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Hospital discharge disposition of stroke patients in Tennessee. / Cho, Jin S.; Hu, Zhen; Fell, Nancy; Heath, Gregory; Qayyum, Rehan; Sartipi, Mina.

In: Southern medical journal, Vol. 110, No. 9, 01.09.2017, p. 594-600.

Research output: Contribution to journalArticle

Cho, Jin S. ; Hu, Zhen ; Fell, Nancy ; Heath, Gregory ; Qayyum, Rehan ; Sartipi, Mina. / Hospital discharge disposition of stroke patients in Tennessee. In: Southern medical journal. 2017 ; Vol. 110, No. 9. pp. 594-600.
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abstract = "Objectives: Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with hospital discharge disposition status and predict such status at the time of an acute stroke admission. Methods: We analyzed 127,581 records of patients with stroke hospitalized between 2010 and 2014. Logistic regression was used to generate odds ratios with 95{\%} confidence intervals to examine the factor outcome association. An easy-to-use clinical predictive tool was built by using integer-based risk scores derived from coefficients of multivariable logistic regression. Results: Among the 127,581 records of patients with stroke, 86,114 (67.5{\%}) indicated home discharge and 41,467 (32.5{\%}) corresponded to facility discharge. All considered patient characteristics had significant correlations with hospital discharge disposition status. Patients were at greater odds of being discharged to another facility if they werewomen; older; black; patients with a subarachnoid or intracerebral hemorrhage; those with the comorbidities of diabetes mellitus, heart disease, hypertension, chronic kidney disease, arrhythmia, or depression; those transferred from another hospital; or patients with Medicare as the primary payer. A predictive tool had a discriminatory capability with area under the curve estimates of 0.737 and 0.724 for derivation and validation cohorts, respectively. Conclusions: Our investigation revealed that the hospital discharge disposition pattern of patients with stroke in Tennessee was associated with the key patient characteristics of selected demographics, clinical indicators, and insurance status. These analyses resulted in the development of an easy-to-use predictive tool for early determination of hospital discharge disposition status.",
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