Services for reducing duration of hospital care for acute stroke patients

Early Supported Discharge Trialists

Published Online:

January 21, 2009

Early discharge services can allow stroke patients to return home early and improve long-term recovery. Early supported discharge services are provided by teams of therapists, nurses and doctors. They aim to allow stroke patients to return home from hospital earlier than usual and receive more rehabilitation at home. Patients who received these services returned home earlier and were more likely to remain at home in the long term and to regain independence in daily activities. The best results were seen with well organised discharge teams and patients with less severe strokes.

Abstract (click to read)

Background:

Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with rehabilitation at home (early supported discharge (ESD)).

Objectives:

To establish the effects and costs of ESD services compared with conventional services.

Search strategy:

We searched the Cochrane Stroke Group's trials register (last searched August 2004) and obtained further information from individual trialists.

Selection criteria:

Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any service intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care.

Data collection and analysis:

Two review authors scrutinised trials and categorised them on their eligibility. Standardised individual patient data was then sought from the primary trialists. Results were analysed for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not.

Main results:

Outcome data are currently available for 11 trials (1597 patients). Patients tended to be a selected elderly group with moderate disability. The ESD group showed significant reductions (P < 0.0001) in the length of hospital stay equivalent to approximately eight days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end of scheduled follow up were OR 0.90, 95% CI 0.64 to 1.27, P = 0.56, OR 0.74, 95% CI 0.56 to 0.96, P = 0.02 and OR 0.79, 95% CI 0.64 to 0.97, P = 0.02, respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild-moderate disability. Improvements were also seen in patients' extended activities of daily living scores (standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers' subjective health status, mood or satisfaction with services.

Authors' conclusions:

Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long term dependency and admission to institutional care as well as reducing the length of hospital stay. No adverse impact was observed on the mood or subjective health status of patients or carers.

This record should be cited as:

Early Supported Discharge Trialists . Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000443. DOI: 10.1002/14651858.CD000443.pub2

Assessed as up to date:

November 16, 2004

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Primary Review Group:

Stroke Group

Health topics:

Heart & circulation > Stroke > Organization of stroke services: education

Neurology > Stroke > Organization of stroke services

Effective practice/health systems > Reviews of specific types of interventions > Organizational interventions

Heart & circulation > Stroke > Organization of stroke services

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Services for reducing duration of hospital care for acute stroke patients

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