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Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care

An Overview and Cost Analysis

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Abstract

Background: Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services.

Objective: To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke.

Methods: A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care.

Results: Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350 ($US11 390)] compared with standard care.

Conclusions: A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.

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References

  1. Warlow CP, Dennis MS, van Gijn J, et al. Stroke: a practical guide to management. Edinburgh: Blackwell Science, 1996

    Google Scholar 

  2. Jamrozik K, Broadhurst RJ, Lai N, et al. Trends in the incidence, severity and short-term outcome of stroke in Perth, Western Australia. Stroke 1999; 30: 2105–11

    Article  PubMed  CAS  Google Scholar 

  3. Anderson CS, Jamrozik KD, Stewart-Wynne EG. Patterns of acute hospital care, rehabilitation, and discharge disposition after acute stroke: the Perth Community Stroke Study 1989–1990. Cerebrovasc Dis 1994; 4: 344–53

    Article  Google Scholar 

  4. Isard PA, Forbes JF. The cost of stroke to the National Health Service in Scotland. Cerebrovasc Dis 1992; 2: 47–50

    Article  Google Scholar 

  5. Aho K, Harmsen P, Hatano S, et al. Cerebrovascular disease in the community: results of a WHO Collaborative Study. Bull World Health Organ 1980; 58: 113–30

    PubMed  CAS  Google Scholar 

  6. Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomised trials of organised in-patient (stroke unit) care after stroke. BMJ 1997; 314: 1151–9

    Article  Google Scholar 

  7. Organising Committee. Asia Pacific consensus forumon stroke management. Stroke 1998; 29: 1730–6

    Article  Google Scholar 

  8. European Ad Hoc Consensus Group. European strategies for early intervention in stroke: a report of an ad hoc consensus group meeting. Cerebrovasc Dis 1996; 6: 315–24

    Article  Google Scholar 

  9. Young J. Is stroke better managed in the community? BMJ 1994; 309: 1356–8

    Article  PubMed  CAS  Google Scholar 

  10. Forster A, Young J. Stroke rehabilitation: can we do better? BMJ 1992; 305: 1446–7

    Article  PubMed  CAS  Google Scholar 

  11. Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2000

    Google Scholar 

  12. Beech R, Rudd AG, Tilling K, et al. Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke 1999; 30: 729–35

    Article  PubMed  CAS  Google Scholar 

  13. Anderson C, Ni Mhurchu C, Rubenach S, et al. Home or hospital for stroke rehabilitation? Results of a randomised controlled trial. II: costminimisation analysis at 6 months. Stroke 2000; 31: 1032–7

    Article  PubMed  CAS  Google Scholar 

  14. McNamee P, Christensen J, Soutter J, et al. Cost analysis of early supported hospital discharge for stroke. Age Ageing 1998; 27: 345–51

    Article  Google Scholar 

  15. Widen Holmqvist L, de Pedro Cuesta J, Moller G, et al. A pilot study of rehabilitation at home after stroke: a health-economic appraisal. Scand J Rehabil Med 1996; 28: 9–18

    PubMed  CAS  Google Scholar 

  16. Anderson C, Rubenach S, Ni Mhurchu C, et al. Home or hospital for stroke rehabilitation? Results of a randomised controlled trial. I: health outcomes at 6 months. Stroke 2000; 31: 1024–31

    Article  PubMed  CAS  Google Scholar 

  17. Australian Hospital Cost Data Collection, 1998/99. Final report of the development of AR-DRG, version 4.1, August 2000. Available from URL: http://www.health.gov.au [Accessed 2002 Jun 19]

    Google Scholar 

  18. Normand ST. Tutorial in biostatistics: meta-analysis: formulating, evaluation, combining, and reporting. Stat Med 1999; 18: 321–59

    Article  PubMed  CAS  Google Scholar 

  19. Mantel W, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22: 710–48

    Google Scholar 

  20. Hedges LV, Olkin I. Statistical methods for meta-analysis. New York (NY): Academic Press, 1985

    Google Scholar 

  21. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–88

    Article  PubMed  CAS  Google Scholar 

  22. Microsoft Excel 97 SR-2 [computer program]. Seattle (WA): Microsoft Corporation, 1985-1997

  23. S-PLUS 2000 [computer program]. Professional release 2. Cambridge (MA): Mathsoft Inc., 1999

  24. Rodgers J, Soutter J, Kaiser W, et al. Early supported hospital discharge following acute stroke: pilot study results. Clin Rehabil 1997; 11: 280–7

    Article  PubMed  CAS  Google Scholar 

  25. Widén Holmqvist L, von Koch L, Kostulas V, et al. A randomised controlled trial of rehabilitation at home after stroke in Southwest Stockholm. Stroke 1998; 29: 591–7

    Article  PubMed  Google Scholar 

  26. Mayo NE, Wood-Dauphinee S, Côté R, et al. There’s no place like home: an evaluation of early supported discharge for stroke. Stroke 2000; 31: 1016–23

    Article  PubMed  CAS  Google Scholar 

  27. Rudd AG, Wolfe CD, Tilling K, et al. Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ 1997; 315: 1039–44

    Article  PubMed  CAS  Google Scholar 

  28. Ronning OM, Guldvog B. Outcome of subacute stroke rehabilitation: a randomized controlled trial. Stroke 1998; 29: 779–84

    Article  PubMed  CAS  Google Scholar 

  29. Indredravik B, Fjaertoft H, Ekeberg G, et al. Benefit of an extended stroke unit service with early supported discharge: a randomized, controlled trial. Stroke 2000; 31: 2989–94

    Article  Google Scholar 

  30. Annual report 1996–1997. Canberra: Australian Commonwealth Department of Health and Family Services, 1997

  31. Brandstater ME. An overview of stroke rehabilitation: a review. Stroke 1986; 17: 363–9

    Article  Google Scholar 

  32. Lafferty G. Community-based alternatives to hospital rehabilitation services: a review of the evidence and suggestions for approaching future evaluations. Rev Clin Gerontol 1996; 6: 183–94

    Article  Google Scholar 

  33. Gladman JRF, Lincoln NB, for the DOMINO Study Group. Follow-up of a controlled trial of domiciliary stroke rehabilitation (DOMINO Study). Age Ageing 1994; 23: 9–13

    Article  PubMed  CAS  Google Scholar 

  34. Young JB, Forster A. The Bradford community stroke trial: results at six months. BMJ 1992; 304: 1085–9

    Article  PubMed  CAS  Google Scholar 

  35. Baskett JJ, Broad JB, Reekie G, et al. Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke. Clin Rehabil 1999; 13: 23–33

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We are grateful to Derrick Bennett of the Clinical Trials Research Unit for his advice with the statistical analyses; to Sally Rubenach for providing us with Australian cost data; to Valery Feigin for his comments on the manuscript; and to the Cochrane Stroke Review Group for their assistance. Cliona Ni Mhurchu undertook this work while holding a Fellowship from the National Heart Foundation of New Zealand. Craig Anderson holds the New Zealand Freemasons Chair of Geriatric Medicine and is a member of the Cochrane Collaboration Stroke Group Editorial Board. There was no direct financial support for this work; there are no conflicts of interest.

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Authors and Affiliations

  1. Clinical Trials Research Unit, University of Auckland, Faculty of Medicine and Health Sciences, Private Bag 92019, Auckland, New Zealand

    Craig Anderson, Cliona Ni Mhurchu & Kristie Carter

  2. Department of Community Health, University of Auckland, Auckland, New Zealand

    Paul M. Brown

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  1. Craig Anderson
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  2. Cliona Ni Mhurchu
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  3. Paul M. Brown
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  4. Kristie Carter
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Correspondence to Craig Anderson.

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Anderson, C., Mhurchu, C.N., Brown, P.M. et al. Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care. Pharmacoeconomics 20, 537–552 (2002). https://doi.org/10.2165/00019053-200220080-00004

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  • DOI: https://doi.org/10.2165/00019053-200220080-00004

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