The (cost)effectiveness of introducing an early admission to and assessment in the nursing home for stroke patients

Every year over 40.000 patients in The Netherlands suffer from a stroke,
frequently resulting in permanent disabilities and handicaps. The care for
stroke patients is traditionally divided into three phases: acute phase,
rehabilitation phase and chronic phase. Care for stroke patients is provided by
a variety of care providers and professionals. To improve stroke care services
and to achieve a better coordination, complementarity and continuity of care
between caregivers, Stroke Services were developed at the end of the last
century. The positive effects of these stroke services have been described in
several studies.

Demographic developments, increased prevalence and incidence of strokes and
changes in the structure of the Dutch health care system have led to new
strategies to improve the quality, efficiency and logistics of care processes
even more. One of the aspects to be implemented and to achieve further
improvement of the quality of care, is an earlier discharge of stroke patients
from the hospital with subsequent comprehensive and tailormade rehabilitation
planning in a nursing home.

Hospitals are especially good in providing care in the acute phase of a stroke.
This care consists of relief, correct and fast diagnosis, stabilisation, acute
treatment and establishing secondary prevention. In the subacute phase
attention must be focussed on rehabilitation. Assessment of the rehabilitating
potential and selecting the right place for rehabilitation must happen in an
integral, adequate and tailormade way. For that purpose the functional
situation of the patient must be mapped closely.
Earlier discharge to a nursing home with extra facilities for assessing the
patients functions in a comprehensive way and to perform tailormade
rehabilitation planning, seems to offer great possibilities.

In 2006, these considerations resulted in the implementation of a renewed
stroke care model aimed at improving this specific aspect of care in the
Maastricht Stroke Service. Moreover, in this way, the duration of hospital stay
for stroke patients can be reduced, leading to an efficiency profit. The
quality of care probably can be maintained or even improved at lower costs.

The purpose of this study is aimed at the effects of early discharge from a
hospital followed by adequate rehabilitation planning in a nursing home. It
concerns a (cost)effective evaluation of a renewed stroke care model that was
implemented in 2006.

The study has a prospective not randomised design, with a comparison between
the region of intervention (surrounding region of the Academic Hospital of
Maastricht) and a region in wich regular stroke care was given.

Patients who participate in the study are asked to answer some questionnaires
and to perform some tasks. On average this wil take about 35 minutes per
measurement. There are no risks involved in the study.