IS EARLY HOSPITAL DISCHARGE AFTER STROKE COMBINED WITH ASSESSMENT IN THE NURSING HOME SAFE AND ACCEPTABLE?
R.W.H. Heijnen, T.D.E.M. Van der Weijden, S.M.A.A. Evers, M. Limburg, B. Winkens, J.M.G.A. Schols
Jour Nursing Home Res 2015;1:96-103
Background: A new stroke care model has been developed aiming at the early hospital discharge of stroke patients to a nursing home for systematic assessment with subsequent planning for rehabilitation. Our hypothesis was that this new model for stroke care improves the delivery of care without affecting quality of life, functional outcomes and satisfaction with care. Design: A non-randomised comparative trial. Setting: Two Dutch stroke services in the regions of Maastricht and Eindhoven. Participants: Acute stroke patients, over 18 years of age. Intervention: Hospital discharge of stroke patient within 5 days to a nursing home, followed by a systematic multidisciplinary assessment in a specialised nursing home assessment unit to determine the optimal rehabilitation track. Usual care consists of an average of 10 days of hospital care, followed by less extensive assessment. Measurements: The primary outcome measures were quality of life and activities of daily living. The primary and secondary outcomes - impairment, cognitive functioning, instrumental activities of daily life, mood, satisfaction with care, caregivers’ strain, length of stay, and medical complications - were assessed using validated instruments. Results: 239 acute stroke patients participated in this study: 122 in the intervention and 117 in the control group. We did not succeed in implementing early discharge from hospital, although the systematic assessment in the nursing home was accomplished. No clinically relevant differences were found between the groups for functional outcomes, quality of life or satisfaction with care. In comparison with the control group, a trend towards reduction in length of nursing home stay was found in the intervention group. Conclusion: Although the new care model failed to implement early discharge, more stroke patients in the intervention group were assessed by a multidisciplinary team in a nursing home in comparison with the usual care group, where more patients were discharged home after their initial hospital stay.
R.W.H. Heijnen ; T.D.E.M. Van der Weijden ; S.M.A.A. Evers ; M. Limburg ; B. Winkens ; J.M.G.A. Schols (2015): Is early hospital discharge after stroke combined with assessment in the nursing home safe and acceptable?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.19