dc.contributor.author | Forster, A | en_US |
dc.contributor.author | Young, J | en_US |
dc.contributor.author | Chapman, K | en_US |
dc.contributor.author | Nixon, J | en_US |
dc.contributor.author | Patel, A | en_US |
dc.contributor.author | Holloway, I | en_US |
dc.contributor.author | Mellish, K | en_US |
dc.contributor.author | Anwar, S | en_US |
dc.contributor.author | Breen, R | en_US |
dc.contributor.author | Knapp, M | en_US |
dc.contributor.author | Murray, J | en_US |
dc.contributor.author | Farrin, A | en_US |
dc.date.accessioned | 2016-09-20T09:21:55Z | |
dc.date.available | 2015-04-06 | en_US |
dc.date.issued | 2015-08 | en_US |
dc.date.submitted | 2016-09-20T08:56:49.606Z | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/15446 | |
dc.description.abstract | BACKGROUND AND PURPOSE: We developed a new postdischarge system of care comprising a structured assessment covering longer-term problems experienced by patients with stroke and their carers, linked to evidence-based treatment algorithms and reference guides (the longer-term stroke care system of care) to address the poor longer-term recovery experienced by many patients with stroke. METHODS: A pragmatic, multicentre, cluster randomized controlled trial of this system of care. Eligible patients referred to community-based Stroke Care Coordinators were randomized to receive the new system of care or usual practice. The primary outcome was improved patient psychological well-being (General Health Questionnaire-12) at 6 months; secondary outcomes included functional outcomes for patients, carer outcomes, and cost-effectiveness. Follow-up was through self-completed postal questionnaires at 6 and 12 months. RESULTS: Thirty-two stroke services were randomized (29 participated); 800 patients (399 control; 401 intervention) and 208 carers (100 control; 108 intervention) were recruited. In intention to treat analysis, the adjusted difference in patient General Health Questionnaire-12 mean scores at 6 months was -0.6 points (95% confidence interval, -1.8 to 0.7; P=0.394) indicating no evidence of statistically significant difference between the groups. Costs of Stroke Care Coordinator inputs, total health and social care costs, and quality-adjusted life year gains at 6 months, 12 months, and over the year were similar between the groups. CONCLUSIONS: This robust trial demonstrated no benefit in clinical or cost-effectiveness outcomes associated with the new system of care compared with usual Stroke Care Coordinator practice. CLINICAL TRIAL REGISTRATION: URL: http://www.controlled-trials.com. Unique identifier: ISRCTN 67932305. | en_US |
dc.format.extent | 2212 - 2219 | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | Stroke | en_US |
dc.rights | CC-BY | |
dc.subject | cluster randomized controlled trial | en_US |
dc.subject | community health services | en_US |
dc.subject | cost-benefit analysis | en_US |
dc.subject | quality-adjusted life years | en_US |
dc.subject | rehabilitation | en_US |
dc.subject | stroke | en_US |
dc.subject | Aged | en_US |
dc.subject | Aged, 80 and over | en_US |
dc.subject | Cluster Analysis | en_US |
dc.subject | Cost-Benefit Analysis | en_US |
dc.subject | Female | en_US |
dc.subject | Follow-Up Studies | en_US |
dc.subject | Humans | en_US |
dc.subject | Long-Term Care | en_US |
dc.subject | Male | en_US |
dc.subject | Middle Aged | en_US |
dc.subject | Stroke | en_US |
dc.title | Cluster Randomized Controlled Trial: Clinical and Cost-Effectiveness of a System of Longer-Term Stroke Care. | en_US |
dc.type | Article | |
dc.rights.holder | © 2015 Bradford Teaching Hospitals NHS Foundation Trust. | |
dc.identifier.doi | 10.1161/STROKEAHA.115.008585 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/26152298 | en_US |
pubs.issue | 8 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 46 | en_US |
dcterms.dateAccepted | 2015-04-06 | en_US |