Early supported discharge for stroke patients improves clinical outcome. Does it also reduce use of health services and costs? One-year follow-up of a randomized controlled trial.
BACKGROUND
An early supported discharge service (ESD) appears to be a promising alternative to conventional care. The aim of this trial was to compare the use of health services and costs with traditional stroke care during a one-year follow-up.


METHODS
Three hundred and twenty patients were randomly allocated either to ordinary stroke unit care or stroke unit care combined with ESD which was coordinated by a mobile team. The use of all health services was recorded prospectively; its costs were measured as service costs and represent a combination of calculated average costs and tariffs. Hospital expenses were measured as costs per inpatient day and adjusted for the DRG.


RESULTS
There was a reduction in average number of inpatient days at 52 weeks in favour of the ESD group (p = 0.012), and a non-significant reduction in total mean service costs in the ESD group (EUR 18,937/EUR 21,824). ESD service seems to be most cost-effective for patients with a moderate stroke.


CONCLUSIONS
Acute stroke unit care combined with an ESD programme may reduce the length of institutional stay without increasing the costs of outpatient rehabilitation compared with traditional stroke care.
Fjaertoft
Hild
H
Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. hild.fjartoft@medisin.ntnu.no
Indredavik
Bent
B
Magnussen
Jon
J
Johnsen
Roar
R
D000367:Age Factors; D000553:Ambulatory Care / Q000191:economics; D017046:Cost Savings; D005500:Follow-Up Studies; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000191:economics / Q000458:organization & administration; D006801:Humans; D010351:Patient Discharge / Q000191:economics* / Q000706:statistics & numerical data*; D011788:Quality of Life; D020521:Stroke / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome