Abstract
Objective: Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision. Design: We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: ‘ESD’ n=135 and ‘Non ESD’ n=158 and 84 caregivers. The ‘ESD’ group accessed either of two ESD services operating in Nottinghamshire, UK. The ‘Non ESD’ group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months. Results: The ESD group had a significantly shorter length of hospital stay (P=0.029) and reported significantly higher levels of satisfaction with services received (P<0.001). Following adjustment for age differences at baseline, participants in the ESD group (n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (P<0.01). Conclusion: The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.
Highlights
Following adjustment for age differences at baseline, participants in the Early Supported Discharge (ESD) group ( n=71) had significantly higher odds of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months respectively in relation to baseline
The health benefits of ESD are still evident when evidence based models of these services are implemented in practice
Stroke patients who were referred to an Early Supported Discharge service, and stroke patients who met the recommended eligibility criteria, but who did not get referred to an Early Supported Discharge service, were recruited to the study and written informed consent obtained
Summary
There is strong evidence for the benefits of Stroke Early Supported Discharge (ESD) services: multidisciplinary teams that co-ordinate the transfer of care from hospital to home and provide specialist rehabilitation in the early stages back at home.[1,2] Meta-analyses of 14 randomised controlled trials (n=1957) have shown that Early Supported Discharge reduces the risk of death and dependency and leads to improvements in patient satisfaction levels, in addition to reducing hospital stay by 8 days.[1,2]On the strength of this evidence base, many countries, including England, recommend the provision of Early Supported Discharge services in national stroke guidelines and policy documents. 3-7 What remains to be investigated is whether Early Supported Discharge is still beneficial when operating in the unpredictable and complex context of frontline healthcare provision.[8]Here we quantitatively investigate whether Early Supported Discharge services that have adopted an evidence based model[9] do achieve what the meta-analyses suggested they would: to accelerate the return home of stroke survivors and produce equivalent or better outcomes for patients than conventional care. On the strength of this evidence base, many countries, including England, recommend the provision of Early Supported Discharge services in national stroke guidelines and policy documents. 3-7 What remains to be investigated is whether Early Supported Discharge is still beneficial when operating in the unpredictable and complex context of frontline healthcare provision.[8]. We quantitatively investigate whether Early Supported Discharge services that have adopted an evidence based model[9] do achieve what the meta-analyses suggested they would: to accelerate the return home of stroke survivors and produce equivalent or better outcomes for patients than conventional care
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