Discharge Destination's Effect on Bounce-Back Risk in Black, White, and Hispanic Acute Ischemic Stroke Patients

Abstract Kind AJH, Smith MA, Liou J-I, Pandhi N, Frytak JR, Finch MD. Discharge destination's effect on bounce-back risk in black, white, and Hispanic acute ischemic stroke patients. Objective To determine whether racial and ethnic effects on bounce-back risk (ie, movement to settings of higher care intensity within 30d of hospital discharge) in acute stroke patients vary depending on initial posthospital discharge destination. Design Retrospective analysis of administrative data. Setting Four hundred twenty-two hospitals, southern/eastern United States. Participants All Medicare beneficiaries 65 years or more with hospitalization for acute ischemic stroke within one of the 422 target hospitals during the years 1999 or 2000 (N=63,679). Interventions Not applicable. Main Outcome Measures Adjusted predicted probabilities for discharge to and for bouncing back from each initial discharge site (ie, home, home with home health care, skilled nursing facility [SNF], or rehabilitation center) by race (ie, black, white, and Hispanic). Models included sociodemographics, comorbidities, stroke severity, and length of stay. Results Blacks and Hispanics were significantly more likely to be discharged to home health care (blacks=21% [95% confidence interval (CI), 19.9–22.8], Hispanic=19% [17.1–21.7] vs whites=16% [15.5–16.8]) and less likely to be discharged to SNFs (blacks=26% [95% CI, 23.6–29.3], Hispanics=28% [25.4–31.6] vs whites=33% [31.8–35.1]) than whites. However, blacks and Hispanics were significantly more likely to bounce back when discharged to SNFs than whites (blacks=26% [95% CI, 24.2–28.6], Hispanics=28% [24–32.6] vs whites=21% [20.3–21.9]). Hispanics had a lower risk of bouncing back when discharged home than either blacks or whites (Hispanics=14% [95% CI, 11.3–17] vs blacks=20% [18.4–22.2], whites=18% [16.8–18.3]). Patients discharged to home health care or rehabilitation centers demonstrated no significant differences in bounce-back risk. Conclusions Racial/ethnic bounce-back risk differs depending on initial discharge destination. Additional research is needed to fully understand this variation in effect.