Costs and caregiver consequences of early supported discharge for stroke patients

Citation Teng, J., Mayo, N. E., Latimer, E., Hanley, J., Wood-Dauphinee, S., Cote, R., & Scott, S. (2002). Costs and caregiver consequences of early supported discharge for stroke patients. Stroke, 34 528-536.

Design Experiment

Purpose The purpose of this study was to estimate the costs associated with an Early Supported Discharge (ESD) program compared with those of usual care.

Hypothesis What is the cost associated with ESD compared to costs of usual care?

Participants Participants were stroke patients who required rehabilitation services and who had a caregiver at home able to provide care for 4 weeks following discharge at home. Persons with cognitive dysfunction following stroke, were excluded from the study. Participants were randomized to either the home intervention (n=58) or the usual care (n=56) group. All participants had a caregiver at home. Their caregivers were also assessed for caregiver burden.

Procedure The group receiving the intervention received a 4-week, tailor-made home program of rehabilitation and nursing services. The usual care group followed current practices for discharge planning and referral for follow-up services. These included services such as an extended acute-care hospital stay, inpatient rehabilitation, outpatient care, private care, and home care provided by a local community health service center (CLSC). Follow-up of study subjects was 3 months after randomization.

Outcomes Providing care at home was no more (or less) expensive for those with greater functional limitation than for those with less. Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care, even caregivers of persons with major functional limitations. For persons recovering from stroke and their families, ESD provides a cost-effective alternative to usual care.

Author Teng, J., Mayo, N. E., Latimer, E., Hanley, J., Wood-Dauphinee, S., Cote, R., & Scott, S.