Services for helping acute stroke patients avoid hospital admission

Area of Science:

• Neurology
• Health Services Research
• Evidence-Based Medicine

Background:

• Acute stroke care and rehabilitation traditionally involve hospital admission.
• Emerging "hospital-at-home" services aim to manage acute stroke patients outside the hospital setting.
• This review evaluates the efficacy and cost-effectiveness of these novel services.

Purpose of the Study:

• To systematically review and compare the costs and effects of "hospital-at-home" services versus conventional stroke care.
• To determine if alternative care models offer comparable or superior outcomes for acute stroke patients.

Main Methods:

• A comprehensive search of the Stroke Group Specialist Register of Controlled Trials was conducted.
• Included were controlled clinical trials comparing "hospital-at-home" interventions with conventional care for acute stroke patients.
• Eligibility, quality assessment, and data extraction were performed by two independent reviewers.

Main Results:

• Four trials involving 921 patients were included; three provided outcome data.
• No statistically significant differences were found in patient or carer outcomes between intervention and control groups.
• A trend indicated increased hospital bed use and higher costs associated with "hospital-at-home" interventions.

Conclusions:

• Existing clinical trial evidence does not support a widespread transition from hospital-based care for acute stroke patients.
• Further research may be needed to identify specific patient groups or service models that could benefit from home-based acute stroke care.