Early Supported Discharge for Stroke Patients Improves Clinical Outcome. Does It Also Reduce Use of Health Services and Costs?

Fjærtoft, Hild; Indredavik, Bent; Magnussen, Jon; Johnsen, Roar

doi:10.1159/000085543

Cited by 39 publications

(35 citation statements)

References 27 publications

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“…[5][6][7][8] This is in accordance with other trials. 3 In this 5-year follow-up, we show that ESD can reduce death and institutional care and can improve patients' chances of living at home up to 5 years after a stroke compared to traditional follow-up care.…”

Section: Discussionsupporting

confidence: 92%

“…Details regarding the study design, the method of randomization, the inclusion criteria, and the intervention have been reported previously. [5][6][7][8] The Regional Committee for Medical Research approved the study protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Randomized controlled trials of early supported discharge (ESD) and further rehabilitation at home have documented great benefits, mostly in reduced length of hospital stay (8 days). 3,4 Some trials also have documented improved functional outcome, improved quality of life, and reduced costs [3][4][5][6][7][8] up to 1 year after stroke. The current recommendation from the ESD trialists group, based on a meta-analysis on 12 randomized controlled trials, 3,4,9 is an ESD service consisting of a coordinating multidisciplinary team, because this is the most effective form of organization in follow-up and rehabilitation.…”

mentioning

confidence: 99%

“…The benefits attributed to the ESD group consisted of improved functional ability, 4,8 healthrelated quality of life, 6 resource use, and reduced costs 7 during the first year after a stroke, as presented. We have also previously explored the association between stroke severity and benefit of ESD versus OSUS.…”

mentioning

confidence: 99%

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Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

Fjærtoft

Rohweder

Indredavik

2011

Stroke

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Background and Purpose-Early supported discharge (ESD) seems to be a promising alternative to conventional follow-up care after acute stroke. We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of resources for up to 1 year. The aim of this trial was to evaluate outcome after 5 years. Methods-We performed a randomized controlled trial with 320 acute stroke patients allocated to ordinary stroke unit care (160 patients) or stroke unit care with ESD (160 patients). The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care. Mortality, residence, and functional outcome including modified Rankin scale were registered after 5 years. All assessments were blinded. Results-There was no difference between the groups with modified Rankin scale score Յ2 (Pϭ0.213), but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke (38% versus 30%; Pϭ0.106). More patients were dead or institutionalized in the ordinary stroke unit care group (Pϭ0.032); 158 patients were alive, 84 were in ESD, and 74 were in ordinary stroke unit care. Of the 158 patients alive, a greater proportion were living at home in ESD (86%/70%; Pϭ0.019). Conclusions-Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients' chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward improved functional outcome in the ESD group. (Stroke. 2011;42:1707-1711.)

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

Fjærtoft

Rohweder

Indredavik

2011

Stroke

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“…Costs were 30-38% lower for the EHSD group after three months, and 13-41% lower after one year. 51,52,53 In particular, the Canadian study by Teng et al found that the costs associated with readmissions were more than four times higher for the conventional care group. 51 Not all patients who are admitted to hospital following a stroke are eligible for EHSD.…”

mentioning

confidence: 99%

Cost Avoidance Associated With Optimal Stroke Care in Canada

Krueger

Lindsay

Côté

et al. 2012

Stroke

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Background and Purpose-Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. Methods-Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008 -2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided.

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