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PAPERS: Anita Patel, Martin Knapp, Andrew Evans, Inigo Perez, and Lalit Kalra Training care givers of stroke patients: economic evaluation BMJ 2004; 328: 1102 [Abstract] [Full text]

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Who Goes Home - And When?

Peter A West   (7 May 2004)

Who Goes Home - And When? 7 May 2004
Peter A West, Director YHEC Ltd Send response to journal: Re: Who Goes Home - And When?	Patel et al show that savings from the stroke carer training were substantially linked to a shorter stay on first admission. The trial is described as single blind but details of the discharge decision are not recorded. If those discharging patients knew who had a trained carer and who did not, then the trial looks suspect. It is clear that there were some benefits but these might have been achieved with less training of carers or by other means that boosted their confidence. This may sound implausible but if a discharge decision was based on knowledge of carer training, then the choice of time of discharge may not be directly or technically linked to the intervention but an indication of when the discharging physician thought the carer could cope. That is, the intervention itself is not shown to be technically linked to a shorter stay (assuming it had no effect on the health state of the patient). While the intervention did appear to have some benefits, the savings from shorter initial stay cannot be directly linked to it from the evidence offered in the paper, though I may be missing something! Competing interests: YHEC is a research company working for the NHS, DH and the pharmaceutical and related industries. We have no current work on stroke and no conflict of interest that we are aware of.