Effectiveness of Stroke Early Supported Discharge

Abstract

Background Implementation of stroke early supported discharge (ESD) services has been recommended in many countries’ clinical guidelines, based on clinical trial evidence. This is the first observational study to investigate the effectiveness of ESD service models operating in real-world conditions, at scale. Methods AND RESULTS Using historical prospective data from the United Kingdom Sentinel Stroke National Audit Programme (January 1, 2016–December 31, 2016), measures of ESD effectiveness were “days to ESD” (number of days from hospital discharge to first ESD contact; n=6222), “rehabilitation intensity” (total number of treatment days/total days with ESD; n=5891), and stroke survivor outcome (modified Rankin scale at ESD discharge; n=6222). ESD service models (derived from Sentinel Stroke National Audit Programme postacute organizational audit data) were categorized with a 17-item score, reflecting adoption of ESD consensus core components (evidence-based criteria). Multilevel modeling analysis was undertaken as patients were clustered within ESD teams across the Midlands, East, and North of England (n=31). A variety of ESD service models had been adopted, as reflected by variability in the ESD consensus score. Controlling for patient characteristics and Sentinel Stroke National Audit Programme hospital score, a 1-unit increase in ESD consensus score was significantly associated with a more responsive ESD service (reduced odds of patient being seen after ≥1 day of 29% [95% CI, 1%–49%] and increased treatment intensity by 2% [95% CI, 0.3%–4%]). There was no association with stroke survivor outcome measured by the modified Rankin Scale. Conclusions This study has shown that adopting defined core components of ESD is associated with providing a more responsive and intensive ESD service. This shows that adherence to evidence-based criteria is likely to result in a more effective ESD service as defined by process measures. REGISTRATION: URL: http://www.isrctn.com/ ; Unique identifier: ISRCTN15568163.

Effect of stroke early supported discharge on length of hospital stay: analysis from a national stroke registry

“…[29][30][31] Our parallel paper added to this debate by highlighting the importance of access to a social worker as part of the ESD team. 15 What was not possible to investigate in this study was whether access to ESD (despite an additional day in hospital) was associated with improved patient outcomes over the longer term. Recent observational studies in Sweden suggest patient and caregiver benefits related to provision of ESD in regular clinical practice, in line with our previous study findings from England.…”

“… 29–31 Our parallel paper added to this debate by highlighting the importance of access to a social worker as part of the ESD team. 15 …”

“…We employed a linear multilevel model framework for both study designs whereby patients (level 1) were clustered within admitting hospitals (level 2) in an approach consistent with previous observational studies of this type. 15 21–24 Within our multilevel models, we adjusted for a range of patient and hospital characteristics as covariates. We chose multilevel modelling to evaluate the effect of ESD on length of hospital stay as it could accommodate and appreciate the variation that existed within and between different admitting hospitals.…”

“…The study reported here, and in a parallel paper exploring the effectiveness of ESD service models, investigates if trial-based benefits of ESD are realised in practice, with the aim to inform evidence based improvements. 15 Here, we focus on the impact of ESD on length of hospital stay.…”

How is the environment integrated into post‐stroke rehabilitation? A qualitative study among community‐dwelling persons with stroke who receive home rehabilitation in Sweden

“…A stroke can lead to physical, emotional and cognitive challenges (Arntzen et al, 2015;Pedersen et al, 2019;Pereira et al, 2020), with a risk of reduced participation in social activities (Hodson et al, 2016;Zingmark et al, 2019). Rehabilitation at home has been shown to be effective (Fisher et al, 2020), but patients and relatives have reported that they lack continuity, information and participation in decisions on continued care and rehabilitation (Nordin et al, 2015). They report experiences of care services that do not meet their needs or are not person-centred (Lindblom et al, 2020), which in turn may limit their possibilities to return to life as it was prior to the stroke.…”