Abstract
Introduction: Early supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients' discharge to home. Previous studies have demonstrated that ESD provides equivalent patient and caregiver outcomes with superior cost-effectiveness compared to conventional rehabilitation (CR). This study intends to examine the feasibility of ESD in Korea.Methods and Analysis: This study is designed as a multicenter assessor-blinded, randomized controlled trial. Ninety post-acute stroke patients with mild to moderate disability (modified Rankin Scale 1–3) will be recruited from three university hospitals (30 patients per hospital) in Korea and allocated to either the ESD group or the CR group in a 1:1 ratio. Patients in the ESD group will receive individualized discharge planning and goal setting, a 4-week home-based rehabilitation program, and liaison service to community-based resources by a multidisciplinary team. Patients in the CR group will receive rehabilitation practices according to their current hospital policy.Outcomes: The primary outcome is the Korean version of the modified Barthel Index, and the primary endpoint was post-onset 3 months. Clinical outcomes, patient/caregiver reported outcomes, and socioeconomic outcomes will be measured at baseline, 1 month after discharge, 2 months after discharge, and 3 months after onset.Discussion: The efficacy and cost-effectiveness of ESD can vary according to the healthcare system and sociocultural aspects. To establish ESD as an alternative transitional care model for post-acute stroke patients in Korea, its feasibility needs to be examined in prior. This study will add evidence on the applicability of ESD in Korea.Ethical Considerations: The study protocol was reviewed and approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB number B-2012/654-308). The study protocol was registered at ClinicalTrials.gov (Identifier NCT04720820). Disseminations will include submission to peer-reviewed journals and presentations at conferences.
Highlights
Supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients’ discharge to home
The feasibility of Early supported discharge (ESD) needs to be examined in the healthcare system environment of Korea, since the applicability of ESD depends on the healthcare system, stroke-related cost, and cultural aspect of the country it is implemented [15]
The healthcare system of Korea offers inpatient medical services at a relatively low cost with good accessibility compared to other developed countries [26] the ESD program might not be an attractive option for stroke patients with moderate to severe disabilities
Summary
Supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients’ discharge to home. Stroke is a significant global healthcare problem, accounting for the second largest disease burden [1] and major health service costs [2] The numbers of both post-stroke survivors and associated healthcare costs are expected to increase in the future [3], which will lead to a strong need for the establishment of an efficient and effective transitional stroke care model. Supported discharge (ESD) is an approach that aims to accelerate the home discharge of post-acute stroke patients by providing an equivalent level of rehabilitation services in the patient’s home setting by a specialized multidisciplinary team [4, 5]. The applicability of the ESD model in Asian countries, namely Korea, remains unclear and requires further validation
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