Comparison of Care and Cost Outcomes for Stroke Patients With and Without Home Care

Abstract

This study was undertaken to compare care and cost outcomes of stroke patients who received home care with those who did not receive home care at St. Luke's Hospital Medical Center, New York, New York. Twenty-five home care stroke patients were matched by age and sex with 25 comparable stroke patients receiving no home care during 1971. After nine months' follow-up, stroke patients who received home care had shorter hospital stays (average, ten days less), overall costs greatly reduced (average, $3,450 for home care patients versus $8,300 for comparison group), fewer readmissions for recurring strokes, and fewer deaths (two versus nine). At the end of nine months, home care patients were located as follows: 20 at home, two on home care, one in a nursing home, and two were dead. The comparison group showed: eight at home, one at an extended-care facility, seven in nursing homes, and nine were dead. The differences in care and cost outcomes between these two groups have considerable implications for patients, hospitals, physicians, and third party payers.

Economic Evaluation in Stroke Research

“…There were no differences in the complication rates and mortality, but the costs in the university hospital were significantly higher. In an older study comparing CVD patients with and without home care, Bryant et al 33 showed that during their 9-month follow-up period, CVD patients who received home care had, in total, a shorter hospital stay, fewer readmissions, and fewer deaths, while overall costs were greatly reduced. Results were not statistically tested.…”

“…Furthermore, in some instances cases were matched with controls (22%). 11,25,27,32,33 Finally, the study by Webb et al 19 combined before-and-after comparison with a prospective cohort, and in the study by Britton et al 20 the diagnostic validity was assessed step by step. Table 2 lists the other epidemiological criteria that were studied for this review.…”

“…Almost half of the studies (48%) include mortality as an outcome measure 14,15,18,19,[21][22][23][24][31][32][33] ; functional outcome and medical complications were also frequently applied. Functional outcomes were measured by 43% of the studies [12][13][14]17,18,[25][26][27]29,34 with general and disease-specific instruments such as the Barthel Index, 12,14,17,26,28 the Glasgow Outcome Scale, 18 the Functional Independence Measure, 13,29 the National Institute of Health Neurological Scale, 18,25 and the Nottingham Health Profile.…”

“…Close to 70% of the studies included in our review tested the differences in both costs and effects statistically. In 2 studies 19,21 the statistical analysis was restricted to only the effects; in 1 study only costs were tested 24 ; and in 4 studies 11,20,26,33 neither effects nor costs were tested statistically. Furthermore, it was striking that in some studies, although no statistical significance was found, the authors concluded that the intervention was cost-effective.…”

Coordinating and Planning Services for Stroke Patients in Hospital and the Community

“…An early study by Bryant et al (1974) in the USA provided strong backing for the concept of home care in the rehabilitation of stroke patients. It found that patients who received home care had shorter hospital stays, greatly reduced costs, fewer readmissions and a lower death rate.…”