Time to home discharge by stroke subtype in a rural stroke care network: A retrospective cohort study.

Stroke discharge timing varies by subtype and by healthcare system capacity; however, evidence from coordinated rural stroke networks remains limited. This study aimed to compare time to home discharge between cerebral infarction (CI) and intracerebral hemorrhage (CH) and examine associations between post-transfer functional independence and discharge destination. We conducted a retrospective cohort study of patients admitted with CI or CH to one tertiary acute-care hospital and six secondary receiving hospitals within a coordinated rural Japanese stroke network between January and December 2024. Time to home discharge and total length of stay (LOS) were analyzed using Mann-Whitney U tests and Kaplan-Meier survival analysis. Functional Independence Measure (FIM) scores at discharge among transferred patients were compared between those discharged home and those discharged to a long-term care facility (LCF). Among 303 eligible patients, 121 were transferred following acute hospitalization. Median LOS was significantly shorter in CI compared with CH (17.0 vs 34 days; P < .001). Kaplan-Meier curves demonstrated earlier home discharge in CI and prolonged, gradual discharge patterns in CH (log-rank test: P < .001). Among transferred patients, median discharge FIM scores were higher among those discharged home in both CI (97 [76-113]) and CH (106 [94-116]), compared with patients discharged to LCFs (both P < .001). Differences in time to home discharge and functional outcomes were observed between stroke subtypes within rural coordinated care pathways. Incorporating subtype-specific considerations into early prognostic evaluation and discharge planning may support more efficient rehabilitation trajectories and resource allocation in rural healthcare systems.