Article

OBJECTIVE: To determine whether racial and ethnic effects on bounce-back risk
(ie, movement to settings of higher care intensity within 30 d 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.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS