Services for helping acute stroke patients avoid hospital admission

Langhorne P, Dennis MS , Kalra L, Shepperd S, Wade DT, Wolfe CDA.

Summary

Provision of hospital-at-home facilities for people experiencing recent strokes versus conventional care

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.