Cost-Effectiveness of Stroke Unit Care Followed by Early Supported Discharge

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.

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Stroke unit care, inpatient rehabilitation and early supported discharge

Clinical Medicine ◽

10.7861/clinmedicine.17-2-173 ◽

2017 ◽

Vol 17 (2) ◽

pp. 173-177 ◽

Cited By ~ 10

Author(s):

Helen Rodgers ◽

Chris Price

Keyword(s):

Stroke Unit ◽

Inpatient Rehabilitation ◽

Early Supported Discharge ◽

Stroke Unit Care

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Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial

Clinical Rehabilitation ◽

10.1191/0269215504cr752oa ◽

2004 ◽

Vol 18 (3) ◽

pp. 238-248 ◽

Cited By ~ 34

Author(s):

T Askim ◽

G Rohweder ◽

S Lydersen ◽

B Indredavik

Keyword(s):

Randomized Controlled Trial ◽

Rural Community ◽

Stroke Unit ◽

Controlled Trial ◽

Randomized Controlled ◽

Early Supported Discharge

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Assessment of Regional Acute Stroke Unit Care in Italy: The PROSIT Study

Cerebrovascular Diseases ◽

10.1159/000068210 ◽

2003 ◽

Vol 15 (1) ◽

pp. 16-18 ◽

Cited By ~ 9

Author(s):

Roberto Sterzi ◽

Giuseppe Micieli ◽

Livia Candelise

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Acute Stroke Unit ◽

Stroke Unit Care

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Effect of Acute Stroke Unit Care Integrated With Care Continuum Versus Conventional Treatment: A Randomized 1-Year Study of Elderly Patients

Stroke ◽

10.1161/01.str.31.11.2578 ◽

2000 ◽

Vol 31 (11) ◽

pp. 2578-2584 ◽

Cited By ~ 54

Author(s):

Björn Fagerberg ◽

Lisbeth Claesson ◽

Gunilla Gosman-Hedström ◽

Christian Blomstrand

Keyword(s):

Elderly Patients ◽

Acute Stroke ◽

Stroke Unit ◽

Conventional Treatment ◽

Care Continuum ◽

Acute Stroke Unit ◽

Stroke Unit Care

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Abstract T P259: What Should Really be Happening to Our Stroke Patients Post-Acute Care?: A System Best Practice Model for Inpatient Rehab

Stroke ◽

10.1161/str.45.suppl_1.tp259 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Shelley Sharp ◽

Elizabeth Linkewich ◽

Jacqueline Willems ◽

Nicola Tahair ◽

Charissa Levy ◽

...

Keyword(s):

Acute Care ◽

Stroke Unit ◽

Best Practice ◽

Patient Flow ◽

System Capacity ◽

Stroke Patients ◽

Practice Model ◽

Term Care ◽

Stroke Unit Care ◽

The Right

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.

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