Early supported discharge services for stroke patients: a meta-analysis of individual patients' data

Langhorne, Peter; Taylor, G.; Murray, Gordon D.; Dennis, Martin; Anderson, Craig S.; Bautz‐Holter, Erik; Dey, Paola; Indredavik, Bent; Mayo, Nancy E.; Power, Michael; Rodgers, Helen; Rønning, Ole Morten; Rudd, Anthony; Suwanwela, Nijasri C.; Widén-Holmqvist, L; Wolfe, Charles D A

doi:10.1016/s0140-6736(05)17868-4

Cited by 174 publications

(87 citation statements)

References 16 publications

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“…Langhorne et al, 71 in a review of the effectiveness of early supported discharge, noted that patients with poor ADLs scores at admission were more likely to enter long-term care. It is important, however, to note that by focusing on individual characteristics, the opportunity to explore the relationship between contextual factors and likely outcome is missed.…”

Section: Resultsmentioning

confidence: 99%

“…As such, it set out to review evidence concerning the effectiveness of IC in preventing admission, as well as literature that has highlighted factors, which might predict admission to care for older people. It should be noted that with the exception of Langhorne et al 71 there exists little analysis on the interaction of the use of IC services, individual factors and admission to institutional care as an outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Pooled data resulted in the inclusion of 89 studies and over 97,000 patients. A further meta-analysis of similar evaluations in the field of stroke 71 noted that ESD evaluations for stroke, including studies with rehabilitation at home, were less likely to result in admission to institutional care (OR 0.74, 95% CI 0.56 to 0.96). This meta-analysis also noted as a significant interaction between mild and moderate initial stroke and institutional care as an outcome.…”

Section: Effectiveness Of Intermediate Care In Reducing Risk Of Admismentioning

confidence: 99%

“…Furthermore, these findings resonate with existing evidence. Langhorne et al, 71 in a review of the effectiveness of early supported discharge, noted that patients with poor ADL scores at admission were more likely to enter long-term care. Although conceptually distinct to ADLs, the relationship between function and participation is clear.…”

Section: Outcomes Of Carementioning

confidence: 99%

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Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Ariss

Enderby

Smith

et al. 2015

Health Services and Delivery Research

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Background and designThis research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characteristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ,et al.The Relationship Between Workforce Flexibility and the Costs and Outcomes of Older Peoples’ Services (COOP). Southampton: National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO); 2010 and Nancarrow SA, Enderby PM, Ariss SM, Smith T, Booth A, Campbell MJ,et al.The Impact of Enhancing the Effectiveness of Interdisciplinary Working (EEICC). Southampton: NIHR SDO; 2012]. Additionally, the impact of different team and staffing structures on patient outcomes and service costs was examined, when possible given the data sets, to enable identification of the most cost-effective service configurations and change over time with service provision. This secondary analysis was placed within updated literature reviews focused on the separate questions.Research objectives(1) To identify those patients most likely to benefit from IC and those who would be best placed to receive care elsewhere; (2) to examine the effectiveness of different models of IC; (3) to explore the differences between IC service configurations and how they have changed over time; and (4) to use the findings above to develop accessible evidence to guide service commissioning and monitoring.SettingCommunity-based services for older people are described in many different ways, among which are IC services and community rehabilitation. For the purposes of this report we call the services IC services and include all community-based provision for supporting older people who would otherwise be admitted to hospital or who would require increased length of stay in hospital (e.g. hospital at home schemes, post-acute care, step-up and step-down services).ParticipantsThe combined data set contained data on 8070 patient admissions from 32 IC teams across England and included details of the service context, costs, staffing/skill mix (800 staff), patient health status and outcomes.InterventionsThe interventions associated with the study cover the range of services and therapies available in IC settings. These are provided by a wide range of professionals and care staff, including nursing, allied health and social care.Outcome measures(1) Service data – each team provided information relating to the size, nature, staffing and resourcing of the services. Data were collected on a service pro forma. (2) Team data – all staff members of the teams participating in both studies provided individual information using the Workforce Dynamics Questionnaire. (3) Patient data – patient data were collected on admission and discharge using a client record pack. The client record pack recorded a range of data utilising a number of validated tools, such as demographic data, level of care (LoC) data, therapy outcome measure (TOM) scale, European Quality of Life-5 Dimensions (EQ-5D) questionnaire and patient satisfaction survey.Results(1) The provision of IC across England is highly variable with different referral routes, team structures, skill mix and cost-effectiveness; (2) in more recent years, patients referred to IC have more complex needs associated with more severe impairments; (3) patients most likely to improve were those requiring rehabilitation as determined by levels 3, 4 and 5 on the LoC (> 40% for impairment, activity and participation, and > 30% for well-being as determined on the TOM scale); (4) half of all patients with outcome data improved on at least one of the domains of the TOM scale; (5) for every 10-year increase in age there was a 6% decrease in the odds of returning home. The chance of remaining or returning home was greater for females than males; (6) a high percentage of patients referred to IC do not require the service; and (7) teams including clinical support staff and domiciliary staff were associated with a small relative improvement in TOM impairment scores when compared with other teams.ConclusionsThis study provides additional evidence that interdisciplinary teamworking in IC may be associated with better outcomes for patients, but care should be taken with overinterpretation. The measures that were used within the studies were found to be reliable, valid and practical and could be used for benchmarking. This study highlights the need for funding high-quality studies that attempt to examine what specific team-level factors are associated with better outcomes for patients. It is therefore important that studies in the future attempt empirically to examine what process-level team variables are associated with these outcomes.FundingThe NIHR Health Services and Delivery Research programme.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Effectiveness Of Intermediate Care In Reducing Risk Of Admismentioning

confidence: 99%

Section: Outcomes Of Carementioning

confidence: 99%

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Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Ariss

Enderby

Smith

et al. 2015

Health Services and Delivery Research

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“…5,6 The hospital-at-home approach changed from a focus on avoiding hospitalization to a focus on early discharge from acute care but with support for ongoing recovery by providing rehabilitation and other services in a community setting. 7 Home rehabilitation for stroke can now be considered under 3 broad rubrics: (1) rehabilitation at home to replace acute care-the early supported discharge (ESD) model; (2) rehabilitation at home to replace institutional rehabilitation; and (3) home exercise to prevent deterioration and promote health through physical activity. The aim of this review is to summarize what lessons have been learned from the many welldesigned clinical trials evaluating the effect of providing ≥1 aspects of stroke rehabilitation in the home and identify promising avenues for implementation so that the greatest good can be achieved for the greatest number of people at the least cost.…”

mentioning

confidence: 99%