***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Early supported discharge ( ESD ) for stroke has been shown to yield outcomes similar to or better than those of conventional care , but there is less information on the impact on costs and on the caregiver . The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care . Methods — We conducted a r and omized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home . Results — Acute-care costs incurred before r and omization when patients were medically ready for discharge averaged $ 3251 per person . The costs for the balance of the acute-care stay , from r and omization to discharge , were $ 1383 for the home group and $ 2220 for the usual care group . The average cost of providing the 4-week home intervention service was $ 943 per person . The total cost generated by persons assigned to the home group averaged $ 7784 per person , significantly lower than the $ 11 065 per person for those assigned to usual care . A large proportion of the cost differential between the 2 groups arose from readmissions , for which the usual care group generated costs more than quadruple those of the home intervention group . Conclusions — Providing care at home was no more ( or less ) expensive for those with greater functional limitation than for those with less . Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care , even caregivers of persons with major functional limitations . For persons recovering from stroke and their families , ESD provides a cost-effective alternative to usual care BACKGROUND Attention is currently focused on family care of stroke survivors , but the effectiveness of support services is unclear . We did a single-blind , r and omised , controlled trial to assess the impact of family support  on stroke patients and their carers . METHODS Patients with acute stroke admitted to hospitals in Oxford , UK , were assigned family support or normal care within 6 weeks of stroke . After 6 months , we assessed , for carers , knowledge about stroke , Frenchay activities index , general health question naire-28 scores , caregiver strain index , Dartmouth co-op charts , short form 36 ( SF-36 ) , and satisfaction scores , and , for patients , knowledge about stroke and use of services , Barthel index , Rivermead mobility index , Frenchay activities index , London h and icap scale , hospital anxiety and depression scales , Dartmouth co-op charts , and satisfaction . FINDINGS 323 patients and 267 carers were followed up . Carers in the intervention group had significantly better Frenchay activities indices ( p=0.03 ) , SF-36 scores ( energy p=0.02 , mental health p=0.004 , pain p=0.03 , physical function p=0.025 , and general health perception p=0.02 ) , quality of life on the Dartmouth co-op chart ( p=0.01 ) , and satisfaction with underst and ing of stroke ( 82 vs 71 % , p=0.04 ) than those in the control group . Patients ' knowledge about stroke , disability , h and icap , quality of life , and satisfaction with services and underst and ing of stroke did not differ between groups . Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge ( 44 vs 56 % , p=0.04 ) , but use of other services was similar . INTERPRETATION Family support significantly increased social activities and improved quality of life for carers , with no significant effects on patients Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event Background and Purpose — Early supported discharge from a stroke unit reduces the length of hospital stay . Evidence of a benefit for the patients is still unknown . The aim of this trial was to evaluate the long-term effects of an extended stroke unit service ( ESUS ) , characterized by early supported discharge . The short-term effects were published previously . Methods — We performed a r and omized controlled trial in which 320 acute stroke patients were allocated to either ordinary stroke unit service ( OSUS ) ( 160 patients ) or stroke unit care with early supported discharge ( 160 patients ) . The ESUS consists of a mobile team that coordinates early supported discharge and further rehabilitation . Primary outcome was the proportion of patients who were independent as assessed by modified Rankin Scale ( RS ) ( RS ≤2=global independence ) . Secondary outcomes measured at 52 weeks were performance on the Barthel Index ( BI ) ( BI ≥95=independent in activities of daily living ) , differences in final residence , and analyses to identify patients who benefited most from an early supported discharge service . All assessment s were blinded . Results — We found that 56.3 % of the patients in the ESUS versus 45.0 % in the OSUS were independent ( RS ≤2 ) ( P = 0.045 ) . The number needed to treat to achieve 1 independent patient in ESUS versus OSUS was 9 . The odds ratio for independence was 1.56 ( 95 % CI , 1.01 to 2.44 ) . There were no significant differences in BI score and final residence . Patients with moderate to severe stroke benefited most from the ESUS . Conclusions — Stroke service based on treatment in a stroke unit combined with early supported discharge appears to improve the long-term clinical outcome compared with ordinary stroke unit care . Patients with moderate to severe stroke benefit most Background : There is evidence that family support can benefit carers of stroke patients , but not the patients themselves . Objective : To extend the follow up of a single blind r and omised controlled trial of family support for stroke patients and carers to one year to ascertain whether there were any late effects of the intervention . Methods : The study was a r and omised controlled trial . Patients admitted to hospital with acute stroke who had a close carer were assigned to  receive family support or normal care .  Families were visited at home by a research er 12 months after the stroke , and a series of question naires was administered to patient and carer . Results : The benefits to carers mostly persisted , though they were no longer statistically significant because some patients were lost to follow up . There was no evidence of any effects on patients . Conclusion : Family support is effective for carers , but different approaches need to be considered to alleviate the psychosocial problems of stroke patients Purpose : To evaluate the feasibility and effectiveness of early supported discharge ( ESD ) following acute stroke . Method : An ESD scheme was compared to conventional rehabilitation in a r and omized controlled trial . All patients admitted with acute stroke were considered for inclusion . Eighty-eight ( 20.2 % ) were found to be eligible and 82 were r and omized either to early supported discharge ( n=42 ) or conventional rehabilitation ( n=40 ) . The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale . The General Health Question naire , the Montgomery Aasberg Depression Rating Scale , mortality , placement and patient and carer satisfaction served as secondary outcome measures . Results : Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group ( p=0.09 ) . No differences were found regarding primary outcome . The General Health Question naire score showed a significant difference in favour of the early supported discharge group at three months ( 19.5/24 , p = 0.02 ) , but not at six . At six months , the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group ( OR 3.8 , 95 % CI 0.8 - 23 ) . Conclusions : Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation Background and Purpose — Readmission rate within 6 months after a stroke is 40 % to 50 % . The purpose of the project was to evaluate whether an interdisciplinary stroke team could reduce length of hospital stay , readmission rate , increase patient satisfaction and reduce dependency of help . Methods — One hundred and ninety-eight patients with acute stroke were r and omized into 103 patients whose discharge was supported by an interdisciplinary stroke team and 95 control patients who received st and ard aftercare .  Baseline characteristics were comparable in the 2 groups . The patients were evaluated after 6 and 12 months regarding functional status and need for help . Results — Length of hospital admission was insignificantly shorter in the intervention compared with the control group ( 35.2 versus 39.8 days ) . There was no significant difference in readmission , GP-visits , and primary health care services . Furthermore , there was no significant difference in functional scores or patient satisfaction . Conclusions — In this setting we could not show benefit of an interdisciplinary stroke team supporting patients at discharge perhaps because st and ard aftercare was very efficient already BACKGROUND Although there have been a number of economic evaluations of cardiac rehabilitation  after acute myocardial infa rct ion ( AMI ) , none has considered only low-risk patients or control groups with no rehabilitation at all . METHODS An economic evaluation was included in a r and omised controlled trial of patients following uncomplicated AMI . Eligible patients were r and omised to return to normal activities after 6 weeks of st and ard rehabilitation ( REHAB , n = 70 ) or to early return to normal activities 2 weeks after AMI with no formal rehabilitation  ( ERNA , n = 72 ) . Outcomes were assessed weekly for 6 weeks , then 3 , 6 and 12 months post-AMI . Outcomes included four quality of life ( QOL ) measures ( physical abilities , distress , usual/social activities , self-care ) and four measures of return to normal activities ( paid and unpaid return to any work and to pre-AMI level of work ) . Statistical analysis included repeated- measures regression ( QOL outcomes ) and survival analysis ( work outcomes ) . RESULTS There were no statistically significant differences between the two groups in any of the outcomes measured or in the use of other health services . The net cost that could be saved by the health service by targeting rehabilitation to high-risk patients was approximately $ 300 ( Australian , 1999 ) per low-risk patient . CONCLUSIONS Early return to normal activities without formal rehabilitation is cost-effective for low-risk patients Objective : To describe the content of a programme involving early hospital discharge and continued rehabilitation at home after stroke . Design : Quantitative and qualitative descriptive study of an intervention within the context of a r and omized controlled trial . Setting : Huddinge University Hospital , Stockholm , Sweden . Subjects : Forty-one patients , moderately impaired after stroke , rehabilitated by a team of six occupational , physical , and speech and language therapists . Results : The average duration of the programme was 14 weeks , the mean number of home visits 12 , and the median total time consumption 23 hours and 20 minutes , of which face-to-face contact with the patient constituted 54 % . The rehabilitation process was pursued by the patient and the therapist in partnership . Supported by the team the therapists incorporated a wider domain of activities than usual and left a considerable amount of the training to self-directed activities . The most common foci of the visits were speech and communication , ADL activities and ambulation . When planning the intervention the therapists paid attention to discrepancies between the desires and abilities of the patient on the one h and and environmental dem and s on the other – discrepancies detected through observation of the patient in the home environment . Conclusions : The home environment offers therapists working in a team opportunities to adopt a behaviour that enables patients with moderate neurological impairments after stroke to resume responsibility and influence over their rehabilitation process , result ing in an individualized rehabilitation programme that varies in duration , content and frequency of home visits BACKGROUND Patients with complex care needs who require care across different health care setting s are vulnerable to experiencing serious quality problems . A care transitions intervention design ed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates . METHODS R and omized controlled trial . Between September 1 , 2002 , and August 31 , 2003 , patients were identified at the time of hospitalization and were r and omized to receive the intervention or usual care .  The setting was a large integrated delivery system located in Colorado . Subjects ( N = 750 ) included community-dwelling adults 65 years or older admitted to the study hospital with 1 of 11 selected conditions . Intervention patients received ( 1 ) tools to promote cross-site communication , ( 2 ) encouragement to take a more active role in their care and to assert their preferences , and ( 3 ) continuity across setting s and guidance from a " transition coach . "  Rates of rehospitalization were measured at 30 , 90 , and 180 days . RESULTS Intervention patients had lower rehospitalization rates at 30 days ( 8.3 vs 11.9 , P = .048 ) and 
    Output:
    
Overall , moderate-strength evidence showed that hospital-initiated support reduced length of stay for patients who had a stroke , and low-strength evidence showed that it reduced mortality for patients who had an MI .
CONCLUSION Available evidence shows that hospital-initiated transitional care can improve some outcomes in adults hospitalized for stroke or MI .