***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 The goal of the present study was to examine the re source and economic implication s of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke . METHODS A cost minimization analysis in conjunction with a r and omized controlled trial was carried out at 2 affiliated teaching hospitals in the southern metropolitan region of Adelaide , South Australia , between 1997 and 1998 . Eighty-six hospitalized patients with acute stroke who required rehabilitation were r and omized to  receive both early hospital discharge and home-based rehabilitation , or conventional in-hospital rehabilitation and community care .  Direct and indirect costs related to stroke rehabilitation were calculated , including hospital bed days , home-based intervention program , community services , and personal expenses during the 6 months after r and omization . RESULTS The mean cost per patient was lower for patients r and omized to the early hospital discharge and home-based rehabilitation ( $ 8040 ) compared with those who received conventional care ( $ 10 054 ) . This cost saving was not statistically significant ( P=0.14 ) . However , sensitivity analyses indicated that the cost of home-based rehabilitation  was consistently lower than that of conventional care except when hospital costs were assumed to be 50 % less than those used in the main analysis . Multiple regression analysis demonstrated that the cost of the home-based program was significantly related to a patient 's level of disability after adjustment for age , comorbidity , and the presence or absence of a caregiver . CONCLUSIONS The early hospital discharge and home-based rehabilitation scheme was less costly than  conventional hospital care for patients with stroke . Limitation of the provision of such services to patients with mild disability is likely to be most cost effective 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 AND PURPOSE In an inner-London teaching hospital , a r and omized trial of " conventional " care versus early discharge to community-based therapy found no significant differences in clinical outcomes between patient groups . This report examines the economic consequences of the alternative strategies . METHODS One hundred sixty-seven patients received the early discharge package , and 164 received conventional care .  Patient utilization of health and social services was recorded over a 12-month period , and cost was determined using data from provider departments and other published sources . RESULTS Inpatient stay after r and omization was 12 days ( intervention group ) versus 18 days ( controls ) ( P=0.0001 ) . Average units of therapy per patient were as follows : physiotherapy , 22.4 ( early discharge ) versus 15.0 ( conventional ) ( P=0.0006 ) ; occupational therapy , 29.0 versus 23.8 ( P=0.002 ) ; speech therapy , 13 . 7 versus 5.8 ( P=0.0001 ) . The early discharge group had more annual hospital physician contacts ( P=0.015 ) and general practitioner clinic visits ( P=0.019 ) but fewer incidences of day hospital attendance ( P=0.04 ) . Other differences in utilization were nonsignificant . Average annual costs per patient were pound sterling 6800 ( early discharge ) and pound sterling 7432 ( conventional ) . The early discharge group had lower inpatient costs per patient ( pound sterling 4862 [ 71 % of total cost ] versus pound sterling 6343 [ 85 % ] for controls ) but higher non-inpatient costs ( pound sterling 1938 [ 29 % ] versus pound sterling 1089 [ 15 % ] ) . Further analysis demonstrated that early discharge is unlikely to lead to financial savings ; its main benefit is to release capacity for an expansion in stroke caseload . CONCLUSIONS Overall results of this trial indicate that early discharge to community rehabilitation for stroke is cost-effective . It may provide a means of addressing the predicted increase in need for stroke care within existing hospital capacity Background and Purpose The aim of the present study was to examine re source utilization during a 12-month period after acute stroke in elderly patients r and omized to care in an acute stroke unit integrated with a care continuum compared with conventional care in general medical wards . A secondary aim was to describe costs related to the severity of stroke . Methods Two hundred forty-nine consecutive patients aged ≥70 years with acute stroke within 7 days before admission , living in their own homes in Göteborg , Sweden , without recognized need of care were r and omized to 2 groups : 166 patients were assigned to nonintensive stroke unit care with a care continuum , and 83 patients were assigned to conventional care . There was no difference in mortality or the proportion of patients living at home after 1 year . Main outcomes were costs from inpatient care , outpatient care , and informal care . Results Mean annual cost per patient was 170 000 Swedish crowns ( SEK ) ( equivalent to $ 25 373 ) and 191 000 SEK ( $ 28 507 ) in the stroke unit and the general medical ward groups , respectively ( P = NS ) . Seventy percent of the total cost was for inpatient care , and 30 % was for outpatient and informal care . For patients with mild , moderate , and severe stroke , the mean annual costs per patient were 107 000 SEK ( $ 15 970 ) , 263 000 SEK ( $ 39 254 ) , and 220 000 SEK ( $ 32 836 ) , respectively ( P < 0.001 ) . There was no statistical difference in age or nonstroke diagnosis . Conclusions The total costs the first year did not differ significantly between the treatment groups in this prospect i ve study . The total annual cost per patient showed a very large variation , which was related to stroke severity at onset and not to age or nonstroke diagnoses . Costs other than those for hospital care constituted a substantial fraction of total costs and must be taken into account when organizing the management of stroke patients . The high variability in costs necessitates a larger study to assess long-term cost effectiveness Background and Purpose — Although stroke units reduce mortality and institutionalization , their comparative cost-effectiveness is unknown . Methods — Healthcare , social services , and informal care costs were compared for 447 acute stroke patients r and omly assigned to stroke unit , stroke team , or domiciliary stroke care . Prospect i ve and retrospective methods were used to identify re source use over 12 months after stroke onset . Cost-effectiveness and cost-utility analyses were undertaken . Results — Mean healthcare and social care costs over 12 months were £ 11 450 for stroke unit , £ 9527 for stroke team , and £ 6840 for domiciliary care . More than half the costs were for the initial episode of care . Institutionalization was a large proportion of follow-up costs . Inclusion of informal care increased costs considerably . When informal care was excluded , the incremental cost-effectiveness ratio per percentage point in deaths or institutionalizations avoided in the first year was £ 496 for the stroke unit over domiciliary care ; incremental cost per quality -adjusted life year quality -adjusted life year gained was £ 64 097 between these 2 groups . The stroke team was dominated by domiciliary care . Conclusions — Cost perspectives , especially those related to long-term and informal care , are important when stroke services are evaluated . Improved health outcomes in the stroke unit come at a higher cost Background and Purpose — Level I evidence from r and omized controlled trials demonstrates that the model of hospital care influences stroke outcomes ; however , the economic evaluation of such is limited . An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes : Providing Effective Services ( SCOPES ) study in Melbourne , Australia . The aim was to describe re source use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units ( SCUs ) . Methods — A prospect i ve , multicenter , cohort study design was used . Costs and outcomes of stroke patients receiving 100 % treatment in 1 of 3 inpatient care models ( SCUs , mobile service , conventional care )  were compared . Health-sector re source use up to 28 weeks was measured in 1999 . Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications . Results — The sample comprised 395 participants ( mean age 73 [ SD 14 ] , 77 % first-ever strokes , males 53 % ) . When compared with conventional care ( n=84 ) , costs for mobile service ( n=209 ) were significantly higher ( P=0.024 ) , but borderline for SCU ( n=102 , P=0.08 ; $ AUD12 251 ; $ AUD15 903 ; $ AUD15 383 respectively ) . This was primarily explained by the greater use of specialist medical services . The incremental cost-effectiveness of SCUs over conventional care was $ AUD9867 per patient achieving thorough adherence to clinical processes and $ AUD16 372 per patient with severe complications avoided , based on costs to 28 weeks . Conclusions — Although acute SCU costs are generally higher , they are more cost-effective than either mobile service or conventional care BACKGROUND AND PURPOSE Treatment of stroke patients in specialized stroke units has become more frequent , yet the effect of this treatment has not been determined . METHODS In a community-based , prospect i ve , and consecutive study of 1241 unselected acute stroke patients , we compared outcome of stroke treatment between two neighboring communities within Greater Copenhagen : the Bispebjerg community , where all acute stroke patients are treated and rehabilitated on a stroke unit , and Frederiksberg community , where all acute stroke patients are treated and rehabilitated on general neurological and medical wards . Except for the different organization of stroke treatment , the two communities and the two patient groups were comparable . Specifically , age , sex , marital status , prestroke residence , and stroke severity were not statistically different between patients treated on the stroke unit and those treated on the general neurological and medical wards . Multivariate regression analyses were used to estimate the independent influence of stroke unit treatment on outcome . RESULTS Stroke unit treatment significantly reduced in-hospital mortality ( odds ratio [ OR ] , 0.50 ; 95 % confidence interval [ CI ] , 0.34 to 0.74 ; P < .001 ) , case-fatality rate ( OR , 0.45 ; CI , 0.28 to 0.71 ; P < .001 ) , 6-month mortality ( OR , 0.57 ; CI , 0.39 to 0.82 ; P = .002 ) , 1-year mortality ( OR , 0.59 ; CI , 0.42 to 0.84 ; P = .003 ) , and discharge rate to a nursing home ( OR , 0.61 ; CI , 0.38 to 0.98 ; P = .04 ) . Discharge rate to the patient 's own home was significantly increased ( OR , 1.90 ; CI , 1.30 to 2.70 ; P < .001 ) . The length of hospital stay ( including rehabilitation ) was reduced significantly by 30 % in patients treated on the stroke unit despite their lower mortality ( P < .001 ) . The savings due to stroke unit treatment were estimated at 1313 bed-days and three places at a nursing home per 100 stroke patients . CONCLUSIONS Treatment of unselected acute stroke patients on a stroke care unit saved lives , reduced the length of hospital stay , reduced the frequency of discharge to a nursing home , and potentially reduced cost Background and Purpose Several trials have shown that stroke unit care improves outcome for stroke patients . The aim of the present trial was to evaluate the effects of an extended stroke unit service ( ESUS ) , with early supported discharge , cooperation with the primary healthcare system , and more emphasis on rehabilitation at home as essential elements . Methods In a r and omized , controlled trial , 160 patients with acute stroke were allocated to the ESUS and 160 to the ordinary stroke unit service ( OSUS ) .  The primary outcome was the proportion of patients who were independent as assessed by the modified Rankin Scale ( RS ) ( RS ≤2=global independence ) and independent in activities of daily living ( ADL ) as assessed by Barthel Index ( BI ) ( BI ≥95=independent in ADL ) after 26 weeks . Secondary outcomes were RS and BI scores after 6 weeks ; the proportion of patients 
    Output:
    
Home-based rehabilitation is unlikely to lead to cost-savings , but achieves better health outcomes .
Care in stroke units is more expensive than conventional care , but leads to improved health outcomes .
The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs .