Authors' objectives: This health technology assessment aims to analyse the following questions: - Should EHSD be offered to stroke patients? - What are the financial barrier to EHSD? - How might the local implementation of EHSD be presented in order to gain support from both the stroke unit management and the social municipality services? - How does EHSD effect patients and their carers?

Authors' recommendations: Despite the positive (socio) economic as well as qualitative effects of EHSD practical constraints do exist. In practice the implementation of domiciliary rehabilitation is expected to be halted by a conflict of financial interests between the hospitals and the municipalities. This is due to the fact that the hospitals which organise the home-based rehabilitation will be left with a financial burden, whereas the municipalities without using any additional resources will save care expenses. To overcome this constraint a flexible model is outlined, where the hospitals are partially compensated for the expenses towards outgoing therapists. In Denmark this financial barrier is supposed to be minimised through an administrative health care reform, which is expected to implemented from 2007. Also, it is important that the ward management in charge of the stroke care units are sufficiently informed about the relative efficiency og the EHSD. As the evidence criterion is essential for clinical decisions, a relatively simple method to calculate the actual number needed to treat (NNT) is outlined. This method is partly based on data from the patient database which shows the target group and its mortality and partly by additional data from the electronic municipal register systems (Faelles Sprog) showing the past use of care resources of the target group. At the same time this preinvestigation raises a dialogue between the stroke unit management and the collaboration body in the municipal social services department. Comparing the expected NNT of EHSD with NNT for an alternative as hypertension treatment might guide the ward management to the optimal path of development. So, the principle of evidence-based medicine is operated just from primary research to clinical practice.

Authors' methods: Review

Project Status: Completed

Year Published: 2005

URL for published report: n/a

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Denmark

Organisation Name: Danish Centre for Evaluation and Health Technology Assessment

Contact Address: National Board of Health, PO Box 1881, Islands Brygge 67, DK-2300 Copenhagen S, Denmark. Tel: 45 72 22 74 48; Fax: 45 72 22 74 07/67

Contact Name: dacehta@sst.dk

Contact Email: dacehta@sst.dk

Copyright: Danish Centre for Evaluation and Health Technology Assessment (DACEHTA)