Abstract for presentation at 6th World Congress on Brain Injury

Objective
The project aims a systematic and comprehensive assessment (HTA) of early supported discharge (ESD) of stroke patients compared to hospital rehabilitation by day-hospitals.
Methods
A systematic, international literature search finds 6 RCT with 994 patients for meta-analysis.
The conventional concept of ESD is narrowed to EHSD stating explicitly that the support of the early discharge must take place at the domicile of the patient
Outcomes are risk of death or institutionalisation (Poor outcomes) and ADL-effect (Barthél Index).
Costs are evaluated in a societal perspective combining sequential data from included trials and Danish implementation projects.
A series of qualitative patient interviews from a Danish implementation.
Results
Poor outcomes has OR=0,59 (0,41-0,83) / NNT=9. This outcome exists at discharge and remains relatively stable during 3 to 12 months follow-up.
The specific outcome for institutionalisation is OR=0,52 (0,28-0,87) / NNT=13.
The improvement in Barthél Index score is strong (weighted effect size = 1,3).
EHSD requires in average the time and costs of 10 extra transports for domiciliary training sessions. Net saving per patient is calculated to 700 USD remaining positive halving savings on bed days and reducing savings on institutionalisation by 25%.
Both patients, relatives and therapists are very satisfied with EHSD.
Conclusion
This HTA concludes that EHSD dominates day-hospitals as rehabilitation strategy for 40-50% of newly diagnosed stroke patients.
The action-mechanism of EHSD is termed the Hawthorne effect of rehabilitation referring to early findings in modern industrial organisation.
Implementation of EHSD of stroke rehabilitation patients must overcome financial barriers between hospitals and community services as well as disciplinary barriers between different professional groups at the hospital.