A review of early supported discharge after stroke

2010 ◽  
Vol 20 (4) ◽  
pp. 327-337 ◽  
Author(s):  
Linda Brewer ◽  
David Williams
Keyword(s):  
Cost Effectiveness ◽  
Discharge Planning ◽  
Stroke Care ◽  
International Studies ◽  
Acute Stroke Care ◽  
Rehabilitation Team ◽  
Early Supported Discharge ◽  
Essential Components ◽  
Bed Days ◽  
The Cost

SummaryStroke is a leading cause of disability worldwide and patients with stroke frequently require prolonged periods of in-patient rehabilitation prior to discharge. This poses a large economic strain on health services, and the cost-effectiveness of this system has been questioned. However, in implementing changes in the delivery of post-acute stroke care it is important that patient outcome is not compromised. Early supported discharge (ESD) was introduced approximately 15 years ago and allows suitable patients to be discharged home early with increased support from a well co-ordinated, multi-disciplinary rehabilitation team in the patient's own home. This paper focuses upon the evidence available from multiple international studies of ESD over the last decade, including both clinical benefit and cost-effectiveness. Findings from these trials are largely positive resulting from a reduction in bed days, therefore overall cost, and an improvement in function and independence reported in many studies. Suitable patient selection, careful discharge planning and continuity of care by the ESD linked to a stroke unit are essential components of the success of this service.

scholarly journals The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

Stroke ◽  
2012 ◽  
Vol 43 (6) ◽  
pp. 1617-1623 ◽  
Author(s):  
Gregory F. Guzauskas ◽  
Denise M. Boudreau ◽  
Kathleen F. Villa ◽  
Steven R. Levine ◽  
David L. Veenstra
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
The Cost

scholarly journals MO2 The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

2012 ◽  
Vol 15 (4) ◽  
pp. A8
Author(s):  
G.F. Guzauskas ◽  
D.M. Boudreau ◽  
K.F. Villa ◽  
S.R. Levine ◽  
D.L. Veenstra
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
The Cost

scholarly journals Cost-Effectiveness of Optimizing Acute Stroke Care Services for Thrombolysis

Stroke ◽  
2014 ◽  
Vol 45 (2) ◽  
pp. 553-562 ◽  
Author(s):  
Maria Cristina Penaloza-Ramos ◽  
James P. Sheppard ◽  
Sue Jowett ◽  
Pelham Barton ◽  
Jonathan Mant ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Care Services

scholarly journals Implementing the NHS England Long Term Plan for stroke: how should reperfusion services be configured? A modelling study

2021 ◽  
Author(s):  
Michael Allen ◽  
Kerry Pearn ◽  
Gary A. Ford ◽  
Phil White ◽  
Anthony Rudd ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Computer Modelling ◽  
Systems Of Care ◽  
Stroke Care ◽  
Net Benefit ◽  
Acute Stroke Care ◽  
Modest Improvement ◽  
Secondary Transfer ◽  
The Cost ◽  
The Impact

Objectives: To guide policy when planning reperfusion thrombolysis (IVT) and thrombectomy (MT) services for acute stroke in England, focussing on the choice between ‘mothership’ (direct conveyance to an MT centre) and ‘drip-and-ship' (secondary transfer for MT after local IVT) provision and the impact of bypassing local acute stroke centres.Methods: Computer modelling was used to estimate the likely outcomes from reperfusion therapies, along with admission numbers to units, based on expected times to IVT and MT.Results: Without pre-hospital selection for LAO, 94% of the population of England live in areas where the greatest clinical benefit accrues from direct conveyance to an IVT/MT centre. If this model was followed then net benefit from reperfusion is predicted to be increased from 31 to 34 additional disability-free outcomes / 1,000 admissions. However, this policy produces unsustainable admission numbers at these centres, and depletes all but 19 IVT-only units of all stroke admissions. Implementing a maximum permitted additional travel time to bypass an IVT-only unit, or using a pre-hospital test for LAO, both increase net benefit over the current drip-and-ship model, but produce a similar destabilising effect on acute systems of care. Use of IVT-only units manage admission numbers to IVT/MT centres.Conclusions: The mothership model reduces time to MT at the cost of increased time to IVT, but the benefit of faster MT is predicted to lead to a modest improvement in overall outcomes. Providing a sustainable national system of acute stroke care requires a hybrid of mothership and drip-and-ship provision.

scholarly journals Cost burden and cost-effective analysis of the nationwide implementation of the Quality in Acute Stroke Care protocol in Australia

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C M Marquina ◽  
Z A Ademi ◽  
E Z Zomer ◽  
R O A Ofori-Asenso ◽  
R T Tate ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Societal Perspective ◽  
Stroke Care ◽  
Decision Analytic Model ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Stroke Incidence ◽  
Care Protocol ◽  
Life Years ◽  
The Cost

Abstract Background The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability. Aim This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective. Methods A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's “value of statistical life year” (AUD 213,000). Results Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke). Conclusions Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective. FUNDunding Acknowledgement Type of funding sources: None. Decision tree PSA

A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial

2018 ◽  
Vol 32 (7) ◽  
pp. 919-929 ◽  
Author(s):  
Kylie Wales ◽  
Glenn Salkeld ◽  
Lindy Clemson ◽  
Natasha A Lannin ◽  
Laura Gitlin ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Activities Of Daily Living ◽  
Incremental Cost ◽  
Acute Care ◽  
Daily Living ◽  
Discharge Planning ◽  
Post Discharge ◽  
The Cost ◽  
Quality Adjusted Life

Objective: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals ( n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.

Abstract 3030: Meta-analysis of Cost Effectiveness of Different Stroke Unit Subtypes

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Minal Jain ◽  
Anunaya Jain ◽  
Abhijit R Kanthala ◽  
Babak S Jahromi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Systems Of Care ◽  
Surrogate Marker ◽  
Cost Effective ◽  
Stroke Care ◽  
Developed Countries ◽  
Direct Care ◽  
Early Supported Discharge ◽  
Acute Rehabilitation

Aim: To perform a systematic review and metanalysis, comparing outcome and cost of stroke care in a stroke unit (SU) versus conventional care (CC). Secondary aim was to compare cost effectiveness of different SU subtypes. Methods: Pubmed search was performed for “Stroke Unit” among all English language articles from 01/01/1996 to 01/01/2011. Only articles from developed countries, reporting the length of stay (LOS) and/or cost and outcomes for ischemic stroke were included. Studies wherein data was collected before 01/01/1996, articles only on rehabilitation units, and all systematic reviews were excluded. LOS was taken as a surrogate marker of stroke care cost in studies wherein direct care costs were not reported. Non-QALY outcomes were converted to QALYs using reported logistic regressions. Ratios less than $50,000/QALY were considered cost effective while greater than $100,000 /QALY were considered non-cost effective. All cost were reported in 2010 US$. Result: A total of 5,537 articles in Pubmed were studied, of which 19 studies met the inclusion criteria. LOS for patients managed at SU ranged from 9.2-32.3 days versus 8-35.3 days for CC units and average incremental QALYs between them were 0.09. The average incremental cost/QALY was $41,204.37. The average cost/QALY for different types of SU were $19,428.64 for Acute only SU (A SU), $44,228.81 for Acute+Rehabilitation SU (A+R SU), $29,145.93 for Acute+Rehabilitation+Early Supported Discharge (A+R+ESD) SU and $20,460.56 for SU with Continuous monitoring (SU CM). In comparison to an A SU, SU CM and A+R+ESD SU were cost effective alternatives (ICER SU CM estimated at $25,120.89, ICER A+R+ESD SU estimated at $24,574.59). Conclusion: Stroke Units are cost effective when compared to the conventional systems of care. Acute + rehab SU with early supported discharge appears to be the most cost effective model amongst different subtypes of SU.

scholarly journals Trends in the Cost-Effectiveness of Stroke Care

2013 ◽  
Vol 16 (7) ◽  
pp. A520
Author(s):  
E. Urbina-Valdespino ◽  
Ö Saka ◽  
S. Crichton ◽  
A. Rudd ◽  
A. Mcguire ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stroke Care ◽  
The Cost

scholarly journals The economic burden of stroke care in England, Wales and Northern Ireland: Using a national stroke register to estimate and report patient-level health economic outcomes in stroke

2017 ◽  
Vol 3 (1) ◽  
pp. 82-91 ◽  
Author(s):  
Xiang-Ming Xu ◽  
Emma Vestesson ◽  
Lizz Paley ◽  
Anita Desikan ◽  
David Wonderling ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Social Care ◽  
Stroke Care ◽  
Stroke Severity ◽  
National Audit ◽  
Patient Level ◽  
Early Supported Discharge ◽  
Health And Social Care ◽  
The Cost ◽  
Care Costs

Introduction Stroke registries are used in many settings to measure stroke treatment and outcomes, but rarely include data on health economic outcomes. We aimed to extend the Sentinel Stroke National Audit Programme registry of England, Wales and Northern Ireland to derive and report patient-level estimates of the cost of stroke care. Methods An individual patient simulation model was built to estimate health and social care costs at one and five years after stroke, and the cost-benefits of thrombolysis and early supported discharge. Costs were stratified according to age, sex, stroke type (ischaemic or primary intracerebral haemorrhage) and stroke severity. The results were illustrated using data on all patients with stroke included in Sentinel Stroke National Audit Programme from April 2015 to March 2016 (n = 84,184). Results The total cost of health and social care for patients with acute stroke each year in England, Wales and Northern Ireland was £3.60 billion in the first five years after admission (mean per patient cost: £46,039). There was fivefold variation in the magnitude of costs between patients, ranging from £19,101 to £107,336. Costs increased with older age, increasing stroke severity and intracerebral hemorrhage stroke. Increasing the proportion of eligible patients receiving thrombolysis or early supported discharge was estimated to save health and social care costs by five years after stroke. Discussion The cost of stroke care is large and varies widely between patients. Increasing the proportion of eligible patients receiving thrombolysis or early supported discharge could contribute to reducing the financial burden of stroke. Conclusion Extending stroke registers to report individualised data on costs may enhance their potential to support quality improvement and research.

Sign in / Sign up

Export Citation Format

Share Document