Comparisons of the cost-effectiveness among hospital chronic care, nursinghome placement, home nursing care and family care for severe stroke patients

Aim. This study compared the cost and effectiveness of long-term institutio nal care and home care for stroke patients with severe physical disabilitie s. Background. Whether home care is more economical or effective than institut ional care for patients with chronic illnesses remains controversial when t he cost of family labour is considered. Thus, decisions concerning the appr opriate type of care setting for patients with severe chronic illness remai n difficult. Methods. From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge u ntil the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiv ing professional care. The change of physical functional status in the pati ent was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after disch arge. Results. Information on family costs for caregiving, including pay for long -term services utilized, labour costs for caregiving and out-of-pocket expe nditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own hom es was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. Conclusions. The results suggest that caring for patients with severe physi cal disabilities in institutions is more appropriate than caring of them at home.