Evaluation of stroke early supported discharge services. Collaborative Leadership in Applied Health Research and Care (CLAHRC), Nottinghamshire, Derbyshire and Lincolnshire, UK

Abstract

A Cochrane systematic review showed that Early Supported Discharge (ESD) following a stroke is both a safe and cost-effective alternative to continued in-patient management. Currently it is unclear whether the health and cost benefits established in the research literature still apply when ESD services are implemented in practice. Our study aims to evaluate the implementation of stroke ESD across three counties in the UK (Nottinghamshire, Derbyshire, Lincolnshire), and offers an innovative approach to facilitate the translation of stroke rehabilitation research into clinical practice. Phase one of our study was to establish the key components of a successful ESD team based on the research literature. We used a modified Delphi approach with ten ESD trialists, who contributed to the Cochrane review, to produce a consensus document. This provides core guidelines for the implementation of an evidence-based ESD service. The second ongoing phase of our study involves the evaluation of ESD services in practice. The evaluation looks at changes in patients' functionality over time, using a range of standardised questionnaires and robust statistical analysis. Such methods can be used by ESD teams in evaluating their effectiveness. Designing an evaluation of an established ESD team has raised some important methodological issues; these include the variability in the length of hospital stay prior to referral to ESD when compared to trials in the Cochrane review, and the subsequent difficulty in defining the optimal baseline time to consent patients. The findings from our research will help inform the implementation and delivery of evidence based ESD services in the UK and abroad.