(Stroke. 1999;30:729-735.)
© 1999 American Heart Association, Inc.
Original Contributions |
Economic Consequences of Early Inpatient Discharge to Community-Based Rehabilitation for Stroke in an Inner-London Teaching Hospital
From the Centre for Health Planning and Management, Keele University, Staffs (R.B.); Elderly Care Unit, St Thomas's Hospital, London (A.G.R.); and Department of Public Health Medicine, United Medical and Dental School, London (K.T., C.D.A.W.), England.
Correspondence to Dr Roger Beech, Centre for Health Planning and Management, Darwin Building, Keele University, Staffs ST5 5BG, England. E-mail r.beech{at}keele.ac.uk
Background and Purpose—In an inner-London teaching hospital, a randomized trial of "conventional" care versus early discharge to community-based therapy found no significant differences in clinical outcomes between patient groups. This report examines the economic consequences of the alternative strategies.
Methods—One hundred sixty-seven patients received the early discharge package, and 164 received conventional care. Patient utilization of health and social services was recorded over a 12-month period, and cost was determined using data from provider departments and other published sources.
Results—Inpatient stay after randomization was 12 days (intervention group) versus 18 days (controls) (P=0.0001). Average units of therapy per patient were as follows: physiotherapy, 22.4 (early discharge) versus 15.0 (conventional) (P=0.0006); occupational therapy, 29.0 versus 23.8 (P=0.002); speech therapy, 13.7 versus 5.8 (P=0.0001). The early discharge group had more annual hospital physician contacts (P=0.015) and general practitioner clinic visits (P=0.019) but fewer incidences of day hospital attendance (P=0.04). Other differences in utilization were nonsignificant. Average annual costs per patient were £6800 (early discharge) and £7432 (conventional). The early discharge group had lower inpatient costs per patient (£4862 [71% of total cost] versus £6343 [85%] for controls) but higher non-inpatient costs (£1938 [29%] versus £1089 [15%]). Further analysis demonstrated that early discharge is unlikely to lead to financial savings; its main benefit is to release capacity for an expansion in stroke caseload.
Conclusions—Overall results of this trial indicate that early discharge to community rehabilitation for stroke is cost-effective. It may provide a means of addressing the predicted increase in need for stroke care within existing hospital capacity.
Key Words: cost-benefit analysis • delivery of care • patient discharge • rehabilitation • stroke management
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