Costs and caregiver consequences of early supported discharge for stroke patients.
OBJECTIVE
Early supported discharge (ESD) for stroke has been shown to yield outcomes similar to or better than those of conventional care, but there is less information on the impact on costs and on the caregiver. The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care.


METHODS
We conducted a randomized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home.


RESULTS
Acute-care costs incurred before randomization when patients were medically ready for discharge averaged $3251 per person. The costs for the balance of the acute-care stay, from randomization to discharge, were $1383 for the home group and $2220 for the usual care group. The average cost of providing the 4-week home intervention service was $943 per person. The total cost generated by persons assigned to the home group averaged $7784 per person, significantly lower than the $11 065 per person for those assigned to usual care. A large proportion of the cost differential between the 2 groups arose from readmissions, for which the usual care group generated costs more than quadruple those of the home intervention group.


CONCLUSIONS
Providing care at home was no more (or less) expensive for those with greater functional limitation than for those with less. Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care, even caregivers of persons with major functional limitations. For persons recovering from stroke and their families, ESD provides a cost-effective alternative to usual care.
Teng
Josephine
J
Joint Department of Biostatistics and Epidemiology and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Mayo
Nancy E
NE
Latimer
Eric
E
Hanley
Jim
J
Wood-Dauphinee
Sharon
S
Côté
Robert
R
Scott
Susan
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011792:Quebec; D012944:Social Support; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation