• Zainab Magdon-Ismail, Alyse Sicklick, Robin Hedeman, Janet Prvu Bettger, and Joel Stein.
• From the Association/American Stroke Association Founders Affiliate, Albany, NY (ZM-I); Gaylord Specialty Healthcare, Wallingford, CT (AS); Kessler Institute for Rehabilitation, West Orange (RH); Duke Clinical Research Institute, Durham, NC (JPB); Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY (JS); Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY (JS); and New York-Presbyterian Hospital, New York, NY (JS).
• Medicine (Baltimore). 2016 Apr 1; 95 (16): e3206e3206.

AbstractThe process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

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