The Effect of Frailty on Discharge Location for Medicare Beneficiaries After Acute Stroke

ObjectiveTo examine the effect of frailty on poststroke discharge location with respect to stroke severity and create a risk-adjusted model for understanding the effects of frailty on discharge to an inpatient rehabilitation facility.DesignRetrospective cohort.SettingA 2014 5% Medicare sample.ParticipantsPatients hospitalized for a first-time acute ischemic stroke (N=7258).InterventionsNot applicable.Main Outcome MeasuresA prehospitalization 6-month baseline was used to calculate a frailty score. Logistic regression to predict odds of discharge to inpatient rehabilitation was used to calculate for 3 levels of baseline frailty, controlling for patient demographics, stroke severity, and comorbidities.ResultsAbout 1603 patients were discharged to inpatient rehabilitation. Patients who were nonfrail (odds ratio OR] 1.716; 95% confidence interval 95% CI], 1.463-2.013) or prefrail (OR 1.519; 95% CI, 1.296-1.779) were more likely to be discharged to inpatient rehabilitation. The final logistic regression model had a C-statistic of 0.63. Most of the patients discharged to inpatient rehabilitation were nonfrail (44.2%) and had moderate strokes (38.9%). Individuals who were frail and suffered a moderate (OR 0.78; 95% CI, 0.558-1.091) or severe stroke (OR 0.509; 95% CI, 0.358-0.721) were less likely to be discharged to an inpatient rehabilitation facility.ConclusionsA lack of a claims-based measure for prestroke functional ability makes it difficult to understand discharge decision-making patterns for individuals’ poststroke. Prestroke frailty was found to have a significant effect on predicating inpatient rehabilitation discharge after an acute stroke when controlling for stroke severity, comorbidities, and age. Further investigation is warranted to examine differences in rehabilitation utilization based on frailty and to quantify the effect of rehabilitation on frailty status in individuals poststroke.