Clinical Question: Do patients with...

Clinical Question: Do patients with pat benefit from early supported discharge services?

Setting: Various (meta-analysis)

consideration Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors used Cochrane Review [i]modus operandi[/i]s to identify 11 randomized trials (1597 patients) of early supported discharge--services that aim to accelerate the discharge of patients already admitted to the hospital. They contacted the original researchers and obtained the individual patients' data to perform a puddleed analysis. The main outcome was the combination of death or adjunct (defined as a Barthel index of les than 19 gone out of 20 or a Rankin score of more than 2) The authors also categorized each program according to the stage and comprehensiveness of the services provided by dint of each early supported discharge program: early supported discharge that was coordinated and delivered by means of a team; early supported discharge that was coordinated according to a team; no early supported discharge team.

Among all patients randomized to early supported discharge, 359 (45 percent) of 804 patients were dead or unable to exist without after 12 months compared with 398 (50 percent) of 793 patients in the have charge of group (number needed to treat = 18; 95 percent confidence interval [CI], 10 to 156) Additionally, the continuance of stay was an average of nearly eight days shorter in all patients in the early supported discharge form into groupss (7.7 days; 95 percent CI, 42 to 107) The trials with a coordinated early supported discharge team performed better than those without. Additionally, five studies analyzed require to be paid [i]or[/i] undergone and all demonstrated a outlay savings of approximately 20 percent Finally, although early supported discharge did not benefit patients with cruel stroke with respect to death and colony this subgroup was released from the hospital 28 days earlier; the subgroup with mild to moderate reverse was released four days earlier.

Bottom Line: In patients admitted to the hospital with mild to moderately simple stroke, early supported discharge services provided by way of special teams reduces the likelihood of death or disability and can lessen the length of hospitalization through one week. (Level of Evidence: 1a)

cogitation Reference: Langhorne P, et al. Early supported discharge services for misfortune patients: a meta-analysis of individual patients' data. Lancet February 5 2005;365:501-6 Used with permission from Barry H Early supported discharge effective for visitation patients. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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