title: Health service management study for stroke: a randomized controlled trial to evaluate two models of stroke care.
abstract: BACKGROUND
  The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial.
  
  
  METHODS
  Patients with acute stroke were randomized on day one of admission to combined, co-located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care. Outcomes measured at baseline and 90 days postdischarge included functional independence measure, length of hospital stay, and functional independence measure efficiency (change in functional independence measure score ÷ total length of hospital stay).
  
  
  RESULTS
  Among 41 patients randomized, 20 were allocated co-located acute/rehabilitation stroke care and 21 traditionally separated acute/rehabilitation stroke care. Baseline measurements showed no significant difference. There was no significant difference in functional independence measure scores between the two groups at discharge and again at 90 days postdischarge (co-located acute/rehabilitation stroke care: 103.6 ± 22.2 vs. traditionally separated acute/rehabilitation stroke care: 99.5 ± 27.7; P = 0.77 at discharge; co-located acute/rehabilitation stroke care: 109.5 ± 21.7 vs. traditionally separated acute/rehabilitation stroke care: 104.4 ± 27.9; P = 0.8875 at 90 days post-discharge). Total length of hospital stay was 5.28 days less in co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (24.15 ± 3.18 vs. 29.42 ± 4.5, P = 0.35). There was significant improvement in functional independence measure efficiency score among participants assigned to co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (co-located acute/rehabilitation stroke care: median 1.60, interquartile range: 0.87-2.81; traditionally separated acute/rehabilitation stroke care: median 0.82, interquartile range: 0.27-1.57, P = 0.0393). Linear regression analysis revealed a high inverse correlation (R(2) = 0.89) between functional independence measure efficiency and time spent in the acute stroke unit.
  
  
  CONCLUSIONS
  This proof-of-concept study has shown that co-located acute/rehabilitation stroke care was just as effective as traditionally separated acute/rehabilitation stroke care as reflected in functional independence measure scores, but significantly more efficient as shown in greater functional independence measure efficiency. Co-located acute/rehabilitation stroke care has potential for significantly improved hospital bed utilization with no patient disadvantage.
authors.affiliation: Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Daniel K Y
authors.initials: DK
authors.lastname: Chan
authors.forename: Chris
authors.initials: C
authors.lastname: Levi
authors.forename: Dennis
authors.initials: D
authors.lastname: Cordato
authors.forename: Fintan
authors.initials: F
authors.lastname: O'Rourke
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.forename: Helen
authors.initials: H
authors.lastname: Redmond
authors.forename: Ying-Hua
authors.initials: YH
authors.lastname: Xu
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.forename: Michael
authors.initials: M
authors.lastname: Pollack
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D000071939:Stroke Rehabilitation; D013997:Time Factors
keywords: FIM efficiency; comprehensive stroke care; health service management; length of stay; postdischarge care; traditional stroke care