Table 14Resource use and transition of care for patients with stroke

System ImprovementsStudiesObservations
Rehospitalization; total hospital daysAndersen et al., 200043MD or PT home visits after discharge from inpatient rehabilitation significantly reduced readmissions at 6 months (26% or 34% versus 44% control; p = 0.028).
Bautz-Holtert et al., 200218Early supported discharge to multidisciplinary team resulted in fewer hospital days than standard care (22 days versus 31 days, p = 0.09).
Donnelly et al., 200448Early supported discharge to multidisciplinary community team care resulted in a nonsignificant reduction in overall hospital days and significantly less use of day hospitals.
Fjaertoft et al., 200521Early supported discharge resulted in fewer hospital days (66.7 versus 85, p = 0.012).
Holmqvist et al., 200025
von Koch et al., 200127
Early supported discharge resulted in fewer overall hospital days, mostly due to the shortened initial hospitalization (15 versus 30, p < 0.0001).
Sulch et al., 200030No difference in overall length of stay of integrated-care pathway versus standard care.
Health care utilizationaMayo et al., 200852Case management did not alter health care utilization.
Sulch et al., 200231Integrated pathway did not alter health care utilization.
Torp et al., 200633Supported discharge did not alter health care utilization.
CostsDonnelly et al., 200448Early discharge with community team supports trend to cost savings but is not significant.
Fjaertoft et al., 200521Early supported discharge was cost-neutral.
Torp et al., 200633Supported discharge was cost-neutral compared to usual care.
Outpatient visits/communicationsFjaertoft et al., 200521Early supported discharge had increase in clinic visits (11.4 versus 8.9, p = 0.027).
Holmqvist et al., 200025
von Koch et al., 200127
Early supported discharge resulted in fewer day hospital and outpatient PT/OT visits compared to the usual care arm.
Mant et al., 200037Family support services resulted in fewer visits to PT compared to control. (44% versus 56%, p = 0.04).
Mayo et al., 200852Case management group has fewer visits to specialists after discharge (2.2 versus 3.4, p = 0.01).
Sulch et al., 200231Integrated-care pathways improved communications with primary MDs (80% versus 45%, p > 0.0001).
Torp et al., 200633Supported discharge did not alter visits to primary care or specialists.
a

Health care utilization includes emergency department visits, rehospitalization, laboratory and diagnostic testing, and revascularization.

Abbreviations: OT = occupational therapy/therapist, PT = physical therapy/therapist

Health care utilization includes emergency department visits, rehospitalization, laboratory and diagnostic testing, and revascularization.

From: Results

Cover of Transition of Care for Acute Stroke and Myocardial Infarction Patients
Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention.
Evidence Reports/Technology Assessments, No. 202.
Olson DWM, Bettger JP, Alexander KP, et al.

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