Is early supported discharge still beneficial in practice?
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Introduction: Randomised controlled trials have shown the benefits of Stroke Early Supported Discharge (ESD). Whether ESD is still beneficial when operating in the unpredictable context of frontline healthcare provision remains unknown. Aim: to evaluate the effectiveness of ESD services operating in practice using a cohort study with quasi experimental design. Methods: 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within 2 naturally formed groups were recruited from 2 acute stroke units: 'ESD' n = 135 and 'Non ESD' n = 158 and 84 caregivers. The 'ESD' group accessed either of 2 ESD services operating in Nottinghamshire. The 'Non ESD' group (no ESD access as GP practice 'out of area') experienced standard practices for discharge and onward referral. Primary outcome measure: Barthel Index measure. Results: The ESD group had a significantly shorter length of hospital stay (p = 0.029) and reported significantly higher levels of satisfaction with services received (p < 0.01). Following adjustment for age differences at baseline, participants in the ESD group (n = 71) had significantly higher odds (compared to the Non ESD group) of being in the >90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (p < 0.01). Discussion: The health benefits of ESD are still evident when evidence based models of these services are implemented in clinical practice.