(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
This article has been cited by other articles:
 |
|
 |
|
  W. Lo, K. Zamel, K. Ponnappa, A. Allen, D. Chisolm, M. Tang, B. Kerlin, and K. O. Yeates The Cost of Pediatric Stroke Care and Rehabilitation Stroke, January 1, 2008; 39(1): 161 - 165. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Luengo-Fernandez, A. M. Gray, and P. M. Rothwell Population-Based Study of Determinants of Initial Secondary Care Costs of Acute Stroke in the United Kingdom Stroke, October 1, 2006; 37(10): 2579 - 2587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N J. A van Exel, W. J. S. op Reimer, W. B. Brouwer, B. van den Berg, M. A Koopmanschap, and G. A. van den Bos Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden Clinical Rehabilitation, February 1, 2004; 18(2): 203 - 214. [Abstract] [PDF]
|
|
|
|
|
|
A. Patel, M. Knapp, I. Perez, A. Evans, and L. Kalra Alternative Strategies for Stroke Care: Cost-Effectiveness and Cost-Utility Analyses From a Prospective Randomized Controlled Trial Stroke, January 1, 2004; 35(1): 196 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Langhorne Editorial Comment--Early Supported Discharge: An Idea Whose Time Has Come? Stroke, November 1, 2003; 34(11): 2691 - 2692. [Full Text] [PDF]
|
|
|
|
|
|
J. Teng, N. E. Mayo, E. Latimer, J. Hanley, S. Wood-Dauphinee, R. Cote, and S. Scott Costs and Caregiver Consequences of Early Supported Discharge for Stroke Patients Stroke, February 1, 2003; 34(2): 528 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Hackett, A. C. Vandal, C. S. Anderson, and S. E. Rubenach Long-Term Outcome in Stroke Patients and Caregivers Following Accelerated Hospital Discharge and Home-Based Rehabilitation Stroke, February 1, 2002; 33(2): 643 - 645. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Wolfe, A. Rudd, M. Dennis, C. Warlow, and P. Langhorne Taking acute stroke care seriously BMJ, July 7, 2001; 323(7303): 5 - 6. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Geddes and M A. Chamberlain Home-based rehabilitation for people with stroke: a comparative study of six community services providing co-ordinated, multidisciplinary treatment Clinical Rehabilitation, June 1, 2001; 15(6): 589 - 599. [Abstract] [PDF]
|
|
|
|
 |
|
 B. Naidoo, W. Stevens, and K. McPherson Modelling the short term consequences of smoking cessation in England on the hospitalisation rates for acute myocardial infarction and stroke Tob. Control, December 1, 2000; 9(4): 397 - 400. [Abstract] [Full Text]
|
|
|
|
|
|
L. Claesson, G. Gosman-Hedstrom, M. Johannesson, B. Fagerberg, and C. Blomstrand Resource Utilization and Costs of Stroke Unit Care Integrated in a Care Continuum: A 1-Year Controlled, Prospective, Randomized Study in Elderly Patients : The Goteborg 70+ Stroke Study Stroke, November 1, 2000; 31(11): 2569 - 2577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. von Koch, L. W. Holmqvist, A. W. Wottrich, K. Tham, and J. de Pedro-Cuesta Rehabilitation at home after stroke: a descriptive study of an individualized intervention Clinical Rehabilitation, June 1, 2000; 14(6): 574 - 583. [Abstract] [PDF]
|
|
|
|
|
|
N. E. Mayo, S. Wood-Dauphinee, R. Cote, D. Gayton, J. Carlton, J. Buttery, and R. Tamblyn There's No Place Like Home : An Evaluation of Early Supported Discharge for Stroke Stroke, May 1, 2000; 31(5): 1016 - 1023. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Anderson, S. Rubenach, C. N. Mhurchu, M. Clark, C. Spencer, and A. Winsor Home or Hospital for Stroke Rehabilitation? Results of a Randomized Controlled Trial : I: Health Outcomes at 6 Months Stroke, May 1, 2000; 31(5): 1024 - 1031. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Anderson, C. N. Mhurchu, S. Rubenach, M. Clark, C. Spencer, and A. Winsor Home or Hospital for Stroke Rehabilitation? Results of a Randomized Controlled Trial : II: Cost Minimization Analysis at 6 Months Stroke, May 1, 2000; 31(5): 1032 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Other Articles Noted Evid. Based Nurs., October 1, 1999; 2(4): 105 - 112. [Full Text]
|
|