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Early home-supported discharge of stroke patients: A health technology assessment

Published online by Cambridge University Press:  09 August 2006

Torben Larsen ,
Tom S. Olsen  and
Jan Sorensen
Torben Larsen
Affiliation:
University of Southern Denmark
Tom S. Olsen
Affiliation:
Hvidovre Hospital
Jan Sorensen
Affiliation:
University of Southern Denmark
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Abstract

Objectives: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units.

Methods: A systematic literature search for randomized trials (RCTs) on “early supported discharge” was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline data are excluded. Seven RCTs on EHSD with 1,108 patients followed 3–12 months after discharge are selected for statistical meta-analysis of outcomes. The costs are calculated as a function of the average number of home training sessions. Economic evaluation is organized as a test of dominance (both better outcomes and lower costs).

Results: The odds ratio (OR) for “Death or institution” is reduced significantly by EHSD: OR = .75 (confidence interval [CI], .46–.95), and number needed to treat (NNT) = 14. Referrals to institution have OR = .45 (CI, .31–.96) and NNT = 20. The reduction of the rate of death is not significant. Length of stay is significantly reduced by 10 days (CI, 2.6–18 days). All outcomes have a nonsignificant positive covariance. The median number of home sessions is eleven, and the average cost per EHSD is 1,340 USD. The “action mechanism” and financial barriers to EHSD are discussed.

Conclusions: EHSD is evidenced as a dominant health intervention. However, financial barriers between municipalities and health authorities have to be overcome. For qualitative reasons, a learning path of implementation is recommended where one stroke unit in a region initiates EHSD for dissemination of new experience to the other stroke units.

Keywords

Early supported dischargeHome care serviceStroke unitSystematic review
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 3 , July 2006 , pp. 313 - 320
Copyright
© 2006 Cambridge University Press

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References

Anderson C, Mhurchu CN, Rubenach S, et al. 2000 Home or hospital for stroke rehabilitation? Results of a randomized controlled trial. II: Cost minimization analysis at 6 months. Stroke. 31: 1032– 1037.Google Scholar
Anderson C, Rubenach S, Mhurchu CN, et al. 2000 Home or hospital for stroke rehabilitation? Results of a randomized controlled trial. I: Health outcomes at 6 months. Stroke. 31: 1024– 1031.Google Scholar
Anderson C, Ni MC, Brown PM, Carter K. 2002 Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: An overview and cost analysis. Pharmacoeconomics. 20: 537– 55.Google Scholar
Bautz-Holtert E, Sveen U, Rygh J, Rodgers H, Wyller TB. 2002 Early supported discharge of patients with acute stroke: A random controlled trial. Disabil Rehabil. 24: 348– 355.Google Scholar
Beech R, Rudd AG, Tilling K, Wolfe CD. 1999 Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner London teaching hospital. Stroke. 30: 729– 735.Google Scholar
Brady BK, McGahan L, Skidmore B. 2005 Systematic review of economic evidence on stroke rehabilitation services. Int J Technol Assess Health Care. 21: 15– 21.Google Scholar
Burton CR. 2000 Living with stroke: A phenomenological study. J Adv Nurs. 32: 301– 309.Google Scholar
Donnelly M, Power M, Russell M, Fullerton K. 2004 Randomised controlled trial of an early discharge rehabilitation service. The Belfast Community Stroke Trial. Stroke. 35: 127– 133.Google Scholar
Early Supported Discharge Trialists. 2002 Services for reducing duration of hospital care for acute stroke patients. Cochrane Database Syst Rev. (1): CD000443.
Fjartoft H, Indredavik B, Lydersen S. 2003 Stroke unit care combined with early supported discharge. Long-term follow-up of a random. Controlled Trial. Stroke. 34: 2687– 2692.Google Scholar
Hobart JC, Lamping DL, Freeman JA, et al. 2001 Evidence-based measurement: Which disability scale for neurologic rehabilitation? Neurology. 57: 639– 644.Google Scholar
Hummelsheim H, Mauritz KH. 1993 The neurophysiological base of exercise physical therapy in patients with central hemiparesis. Fortschr Neurol Psychiatr. 61: 208– 216.Google Scholar
Indredavik B, Fjaertoft H, Ekeberg G, Loge AD, Morch B. 2000 Benefit of an extended stroke unit service with early supported discharge: A randomized, controlled trial. Stroke. 31: 2989– 2994.Google Scholar
Langhorne P, Taylor G, Murray G, et al. 2005 Early supported discharge services for stroke patients: A meta-analysis of individual patient data. Lancet. 365: 501– 506.Google Scholar
Lipsey MW, Wilson DB. Practical meta-analysis. 2000 London: Sage Publications Ltd..
Mayo NE, Wood-Dauphinee S, Cote R, et al. 2000 There's no place like home: An evaluation of early supported discharge for stroke. Stroke. 31: 1016– 1023.Google Scholar
McNamee P, Christensen J, Soutter J, et al. 1998 Cost analysis of early supported hospital discharge for stroke. Age Ageing. 27: 345– 351.Google Scholar
Oostenbrink JB, Koopmanschap MA, Rutten FFH. 2002 Standardisation of costs– The Dutch manual for costing in economic evaluations. Pharmacoeconomics. 20: 443– 454.Google Scholar
Rodgers H, Soutter J, Kaiser W, et al. 1997 Early supported hospital discharge following acute stroke: Pilot study results. Clin Rehabil. 11: 280– 287.Google Scholar
Ronning OM, Guldvog B. 1998 Outcome of subacute stroke rehabilitation: A randomized controlled trial. Stroke. 29: 779– 784.Google Scholar
Rudd AG, Wolfe CD, Tilling K, Beech R. 1997 Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ. 315: 1039– 1044.Google Scholar
Suenkeler MN, Misselwitz B, Kugler C, et al. 2002 Timecourse of health-related quality of life as determined 3, 6 and 12 months after stroke –relationship to neurological deficit, disability and depression. J Neurol. 249: 1160– 1167.Google Scholar
Suwanwela NC, Phanthumchinda K, Limtongkul S, Suvanprakorn P. 2002 Comparison of short (3-day) hospitalization followed by home care treatment and conventional (10-day) hospitalization for acute ischemic stroke. Cerebrovasc Dis. 13: 267– 271.Google Scholar
Teng J, Mayo NE, Latimer E, et al. 2003 Costs and caregiver consequences of early supported discharge for stroke patients. Stroke. 34: 528– 536.Google Scholar
Thorsén AM, Widén Holmquist L, de Petro-Custa J, von Koch L. 2005 A randomized controlled trial of early supported discharge and continued rehabilitation at home after stroke. Stroke. 36: 297– 302.Google Scholar
von Koch L, Pedro-Cuesta J, Kostulas V, Almazan J, Widen HL. 2001 Randomized controlled trial of rehabilitation at home after stroke: One-year follow up. Cerebrovasc Dis. 12: 131– 138.Google Scholar
von Koch L, Widén Holmquist L, Kostulas V, Almazan J, de Petro-Custa J. 2000 A randomised controlled trial of rehabilitation at home after stroke in southwest Stockholm: Outcome at six months. Scand J Rehabil Med. 32: 80– 86.Google Scholar
Warlow CP, Dennis MS, van Gijn J, et al. 2001. Stroke: A practical guide to management. Oxford: Blackwell Science;