, Volume 20, Issue 8, pp 537–552 | Cite as

Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care

An Overview and Cost Analysis
  • Craig Anderson
  • Cliona Ni Mhurchu
  • Paul M. Brown
  • Kristie Carter
Original Research Article


Background: Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services.

Objective: To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke.

Methods: A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care.

Results: Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350 ($US11 390)] compared with standard care.

Conclusions: A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.


Standard Care Institutional Care Early Discharge Stroke Rehabilitation Australian Hospital 



We are grateful to Derrick Bennett of the Clinical Trials Research Unit for his advice with the statistical analyses; to Sally Rubenach for providing us with Australian cost data; to Valery Feigin for his comments on the manuscript; and to the Cochrane Stroke Review Group for their assistance. Cliona Ni Mhurchu undertook this work while holding a Fellowship from the National Heart Foundation of New Zealand. Craig Anderson holds the New Zealand Freemasons Chair of Geriatric Medicine and is a member of the Cochrane Collaboration Stroke Group Editorial Board. There was no direct financial support for this work; there are no conflicts of interest.


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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Craig Anderson
    • 1
  • Cliona Ni Mhurchu
    • 1
  • Paul M. Brown
    • 2
  • Kristie Carter
    • 1
  1. 1.Clinical Trials Research UnitUniversity of Auckland, Faculty of Medicine and Health SciencesAucklandNew Zealand
  2. 2.Department of Community HealthUniversity of AucklandAucklandNew Zealand

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