Variations in rates of discharges to nursing homes after acute hospitalization for stroke and the influence of service heterogeneity: an Anglia Stroke Clinical Network Evaluation Study

Michelle Tornes* (Corresponding Author), David McLernon, Max Bachmann, Stanley Musgrave, Diana Day, Elizabeth A Warburton, John Potter, Phyo Kyaw Myint

*Corresponding author for this work

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Nursing home placement after stroke indicates a poor outcome but numbers placed vary between hospitals. The aim of this study is to determine whether between-hospital variations in new nursing home placements post-stroke are reliant solely on case-mix differences or whether service heterogeneity plays a role. A prospective, multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospitals within the Anglia Stroke and Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospitals (as a fixed-effect) and rates of new discharges to nursing homes using multiple logistic regression, adjusting for important patient risk factors. Descriptive and graphical data analyses were undertaken to explore the role of hospital characteristics. Of 1335 stroke admissions, 135 (10%) were discharged to a nursing home but rates varied considerably from 6% to 19% between hospitals. The hospital with the highest adjusted odds ratio of nursing home discharges (OR 4.26; 95% CI 1.69 to 10.73), was the only hospital that did not provide rehabilitation beds in the stroke unit. Increasing hospital size appeared to be related to an increased odds of nursing home placement, although attenuated by the number of hospital stroke admissions. Our results highlight the potential influence of hospital characteristics on this important outcome, independently of patient-level factors.
Original languageEnglish
Article number390
Number of pages13
Issue number4
Publication statusPublished - 9 Oct 2020

Bibliographical note

Funding: This work was funded by the National Institute For Health Research (NIHR) Research For Patient Benefit Programme, grant number PB-PG-1208-18240. E.A.W. receives funding support from the NIHR Biomedical Research Centre award to Cambridge. MT received a PhD studentship funded by the College Of Life Sciences & Medicine, University Aberdeen, grant number CF10109–38.
Acknowledgments: We thank the stroke database team and stroke research team staff from all participating sites who contributed to data collection. We also would like to acknowledge the contribution of Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group. ASCNES Group (alphabetical order): Max O Bachmann (UEA); Garry R Barton (UEA); Fiona Cummings (ASHCN); Genevieve Dalton (ASHCN); Diana J Day (ASHCN/AH); Abraham George (JPUH); Rachel Hale (UEA); Anthony Kneale Metcalf (NNUH/UEA); Stanley D Musgrave (UEA);
Phyo Kyaw Myint (UoA/UEA); Joseph Ngeh (IPH); Anne Nicholson (WSH); Peter Owusu-Agyei (PH); John F Potter (UEA/NNUH) and Gill M Price (UEA).


  • nursing home
  • institutionalization
  • acute hospitals
  • health services research
  • stroke
  • UK
  • NHS
  • CARE


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