Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital

Background and Purpose-In an inner-London teaching hospital, a randomized t rial of "conventional" care versus early discharge to community-based thera py found no significant differences in clinical outcomes between patient gr oups. This report examines the economic consequences of the alternative str ategies. Methods-One hundred sixty-seven patients received the early discharge packa ge, and 164 received conventional care. Patient utilization of health and s ocial services was recorded over a 12-month period, and cost was determined using data from provider departments and other published sources. Results-lnpatient stay after randomization was 12 days (intervention group) versus 18 days (controls) (P=0.0001). Average units of therapy per patient were as follows: physiotherapy, 22.4 (early discharge) versus 15.0 (conven tional) (P=0.0006); occupational therapy, 29.0 versus 23.8 (P=0.002); speec h therapy, 13.7 versus 5.8 (P=0.0001). The early discharge group had more a nnual hospital physician contacts (P=0.015) and general practitioner clinic visits (P=0.019) but fewer incidences of day hospital attendance (P=0.04). Other differences in utilization were nonsignificant. Average annual costs per patient were pound 6800 (early discharge) and pound 7432 (conventional ). The early discharge group had lower inpatient costs per patient (pound 4 862 [71% of total cost] versus pound 6343 [85%] for controls) but higher no n-inpatient costs (pound 1938 [29%] versus pound 1089 [15%]). Further analy sis demonstrated that early discharge is unlikely to lead to financial savi ngs; its main benefit is to release capacity for an expansion in stroke cas eload. Conclusions-Overall results of this trial indicate that early discharge to community rehabilitation for stroke is cost-effective. It may provide a mea ns of addressing the predicted increase in need for stroke care within exis ting hospital capacity.