1 Post-acute stroke patient outcomes in Ontario, Canada complex continuing care settings Ann Tourangeau 1 , Mae Squires 2 , Walter Wodchis 3 , Katherine McGilton 4 , Gary Teare 5 , Kimberly Widger 6 1.2,6 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada 3 Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada 4 Toronto Rehabilitation Institute, Ontario, Canada 5 Health Quality Council, Saskatchewan, Saskatoon, Saskatchewan, Canada Published 2011 in Disability and Rehabilitation, 33(2), 98-104 http://informahealthcare.com/doi/abs/10.3109/09638288.2010.486466 ABSTRACT Purpose: Outcomes are described for a sample of patients receiving less intensive and longer duration rehabilitation while recovering from stroke in Ontario complex continuing care (CCC) healthcare settings (similar to chronic care). Methods: In 2006-2007, 81 post-acute stroke patients recovering in six Ontario, Canada CCC healthcare settings were studied. Both primary and secondary sources of data were used to calculate six clinical characteristics of study patients and three outcomes: patient satisfaction with CCC care, discharge location, and length of CCC stay. As well as descriptive statistics, tests of difference were employed to examine differences in clinical characteristics and outcomes for patients across facilities. Results: Mean patient age was 74 years, 59% were female, 51% were married, and 34.6% lived alone prior to hospitalization. Data on six clinical characteristics is described for study patients. Almost half of patients were discharged to independent or semi-independent living. Mean length of stay was 112.8 days. Mean scores for patient-reported experiences with CCC care were 71 (out of 100). There were statistically significant differences in all outcomes across healthcare facilities. Conclusions: : Less intensive and longer duration rehabilitation was successful in transitioning the majority of patients to independent living or to a healthcare setting providing less intensive care. Opportunities exist to promote increased patient satisfaction with care. Key Words: Stroke, patient satisfaction, discharge location, length of stay, RAI-MDS Introduction The prevalence of cerebral vascular disease in Ontario, Canada is 1.9 for every 100 persons but in some areas is as high as 2.5 per 100 persons [1]. Stroke is a serious consequence of cerebral vascular disease and is the fourth leading cause of death in Canada. Stroke has significant impact on patients and families with almost 60% of stroke survivors suffering from moderate to severe impairment as well as some being so disabled that they require ongoing placement in long-term care facilities [2]. With a growing elderly population, the incidence of stroke is expected to increase [3]. Understanding these patients and their outcomes is imperative. Some patients recovering from stroke may be well enough for discharge from acute care hospitals to home or previous living situations. Others may require continuing institutional healthcare. Those recovering from stroke and assessed to tolerate intensive rehabilitation (e.g., several hours of rehabilitation therapy daily) are usually discharged from acute care hospital to a traditional rehabilitation programme. However, some post- acute stroke patients are assessed as too frail to tolerate intensive rehabilitation of several hours of rehabilitation therapy daily but could benefit from lower intensity rehabilitation of up to 1 h of rehabilitation therapy daily that spans a longer period of time than that usually provided in traditional rehabilitation programmes. In complex continuing care (CCC) (chronic care) settings in Ontario, Canada, post-acute stroke patients can receive ‘slow stream’ or less intensive inpatient rehabilitation therapy of approximately five hours of rehabilitation therapy per week [3,4–6]. In Ontario, this type of post-acute ‘slow stream’ rehabilitation is termed ‘low tolerance long duration rehabilitation.’ Such slow stream rehabilitation programmes have existed in other countries such as Australia for more than two decades [7]. The primary goal for these patients is to transfer care from CCC settings back to the community or to healthcare settings providing less care [8]. Without this programme of low intensity rehabilitation therapy, those post-acute stroke patients assessed as not having capacity to benefit from or tolerate intensive rehabilitation therapy (e.g., rehabilitation therapy of several hours duration daily) would be discharged directly from acute care hospital to long-term care facilities such as chronic care hospitals or nursing homes without having the opportunity to receive focused rehabilitation therapy. This article focuses on describing the clinical characteristics and outcomes for post- acute stroke patients discharged from acute care hospital to low tolerance long duration rehabilitation programmes (slow stream or less intensive) provided in Ontario CCC settings. Very little has been written about this patient population [9]. This research begins to address this knowledge gap. The purpose of this article is to describe health-related characteristics of post-acute stroke patients recovering in Ontario CCC settings as well as their performance or ratings on three outcomes: patient satisfaction