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Intervention Review

Services for helping acute stroke patients avoid hospital admission

  1. Peter Langhorne1,*,
  2. Martin Dennis2,
  3. Lalit Kalra3,
  4. Sasha Shepperd4,
  5. Derick Wade5,
  6. Charles DA Wolfe6

Editorial Group: Cochrane Stroke Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 2 MAY 1999

DOI: 10.1002/14651858.CD000444

Database Title

Additional Information

How to Cite

Langhorne P, Dennis M, Kalra L, Shepperd S, Wade D, Wolfe CDA. Services for helping acute stroke patients avoid hospital admission. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD000444. DOI: 10.1002/14651858.CD000444.

Author Information

  1. 1

    University of Glasgow, Academic Section of Geriatric Medicine, Glasgow, UK

  2. 2

    University of Edinburgh, Division of Clinical Neurosciences, Edinburgh, UK

  3. 3

    Guy's, King's & St Thomas' School of Medicine, Department of Medicine, London, UK

  4. 4

    University of Oxford, Department of Public Health, Oxford, Oxfordshire, UK

  5. 5

    University of Oxford, Oxford Centre for Enablement, Oxford, UK

  6. 6

    Kings College London, University of London, Population Sciences & Health Care Research Medicine, London, UK

*Peter Langhorne, Academic Section of Geriatric Medicine, University of Glasgow, 3rd Floor, Centre Block, Royal Infirmary, Glasgow, G4 0SF, UK. p.langhorne@clinmed.gla.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Stroke patients are usually admitted to hospital for their acute care and rehabilitation. Services to help acute stroke patients avoid admission to hospital ('hospital-at-home') have now been developed.

Objectives

To establish the costs and effects of such services compared with conventional services.

Search methods

We searched the Cochrane Stroke Group Trials Register in March 1999 and supplemented this through discussion with colleagues and trialists.

Selection criteria

Controlled clinical trials recruiting stroke patients who have not been admitted to hospital and compare (1) services which provided support with an aim of helping prevent admission to hospital with (20 conventional services (which could include hospital admission).

Data collection and analysis

Two independent review authors determined the eligibility and methodological quality of trials. Trialists were then contacted to obtain standardised descriptive and outcome data.

Main results

Four trials are included in the review, of which three currently have outcome data available (921 patients; 857 from one controlled trial, 64 from two randomised trials). There were no statistically significant differences between the patient and carer outcomes of the intervention and control groups either within individual trials or in pooled analyses. There was a trend toward greater hospital bed use and increased costs in the intervention groups.

Authors' conclusions

There is currently no evidence from clinical trials to support a radical shift in the care of acute stroke patients from hospital-based care.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Services for helping acute stroke patients avoid hospital admission

A person experiences a stroke when a blood clot blocks a blood vessel in or to the brain or when there is bleeding in the brain. The damage caused (focal neurological deficit) is a major cause of death and disability. Stroke patients are usually admitted to hospital, either into special stroke units or general wards, for immediate health care, physical support and rehabilitation. It may be possible to avoid admission to hospital or to reduce the length of stay by providing community support. This is known as hospital-at-home. The reasoning is that home services can provide equivalent or better patient outcomes at a lower cost and that they are likely to be preferred by patients and carers. The review authors searched the medical literature looking for controlled studies that compared care of people with recent strokes at home using a community support team versus conventional care using the usual referral process by a general practitioner or local service and which includes admission to hospital. Patient and carer outcomes reflecting the consequences of disability, death, dependency and requirement for change of residence were not obviously different with the two types of healthcare service, based on three studies. It was not clear that the need for a hospital bed was less with hospital-at-home care. These studies had a total of 921 people assessed three to 12 months after a stroke. The majority of participants (857 people) were from one of the studies where the service they received was based on the medical general practice they attended. Determining how a person felt about their health, their mood and satisfaction with healthcare management was difficult to assess because many people were unable to complete the details in a questionnaire because of the effects of their stroke. The small number of studies and the number of participants make it difficult to determine any harms of treatment at home. The evidence did not seem to justify a radical shift in the care of acute stroke patients from hospital-based care.

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