Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital.
OBJECTIVE
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 pound sterling 6800 (early discharge) and pound sterling 7432 (conventional). The early discharge group had lower inpatient costs per patient (pound sterling 4862 [71% of total cost] versus pound sterling 6343 [85%] for controls) but higher non-inpatient costs (pound sterling 1938 [29%] versus pound sterling 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.
Beech
R
R
Centre for Health Planning and Management, Keele University, Staffs, England. r.beech@keele.ac.uk
Rudd
A G
AG
Tilling
K
K
Wolfe
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CD
D000368:Aged; D002561:Cerebrovascular Disorders / Q000191:economics* / Q000534:rehabilitation; D018672:Community Health Planning / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006784:Hospitals, Teaching / Q000191:economics*; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008131:London; D009788:Occupational Therapy / Q000191:economics / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000191:economics*; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data; D011897:Random Allocation; D012047:Rehabilitation Centers / Q000191:economics* / Q000706:statistics & numerical data; D013070:Speech Therapy / Q000191:economics