Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.
BACKGROUND
Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services.


METHODS
We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up.


RESULTS
Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability.


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 shortening hospital stays.
Langhorne
Peter
P
Academic Section of Geriatric Medicine, Level 3, Centre Block, Royal Infirmary, Glasgow G4 OSF, UK. P.Langhorne@clinmed.gla.ac.uk
Taylor
Gillian
G
Murray
Gordon
G
Dennis
Martin
M
Anderson
Craig
C
Bautz-Holter
Erik
E
Dey
Paola
P
Indredavik
Bent
B
Mayo
Nancy
N
Power
Michael
M
Rodgers
Helen
H
Ronning
Ole Morten
OM
Rudd
Anthony
A
Suwanwela
Nijasri
N
Widen-Holmqvist
Lotta
L
Wolfe
Charles
C
D000203:Activities of Daily Living; D000368:Aged; D018575:Home Care Services, Hospital-Based; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D010348:Patient Care Team; D010351:Patient Discharge; D017060:Patient Satisfaction; D000071939:Stroke Rehabilitation