Economic Consequences of Early Inpatient Discharge to Community-Based Rehabilitation for Stroke in an Inner-London Teaching Hospital

Abstract

Background and Purpose —In an inner-London teaching hospital, a randomized trial of “conventional” care versus early discharge to community-based therapy found no significant differences in clinical outcomes between patient groups. This report examines the economic consequences of the alternative strategies. Methods —One hundred sixty-seven patients received the early discharge package, and 164 received conventional care. Patient utilization of health and social services was recorded over a 12-month period, and cost was determined using data from provider departments and other published sources. Results —Inpatient 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 (conventional) ( P =0.0006); occupational therapy, 29.0 versus 23.8 ( P =0.002); speech therapy, 13.7 versus 5.8 ( P =0.0001). The early discharge group had more annual 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 £6800 (early discharge) and £7432 (conventional). The early discharge group had lower inpatient costs per patient (£4862 [71% of total cost] versus £6343 [85%] for controls) but higher non-inpatient costs (£1938 [29%] versus £1089 [15%]). Further analysis demonstrated that early discharge is unlikely to lead to financial savings; its main benefit is to release capacity for an expansion in stroke caseload. Conclusions —Overall results of this trial indicate that early discharge to community rehabilitation for stroke is cost-effective. It may provide a means of addressing the predicted increase in need for stroke care within existing hospital capacity.