Effectiveness and cost-effectiveness of early assisted discharge for Chronic Obstructive Pulmonary Disease exacerbations: the design of a randomised controlled trial

BMC Public Health

Study Protocol

Onno CP van Schayck¹  Loes van Eijsden²  Peter J de Bruijn³  Anouschka van der Pouw³  Wiel Seezink⁴  Monique van Vliet⁴  Walter van Litsenburg⁵  Frank WJM Smeenk⁵  Annet Janssen⁵  Cecile MA Utens⁶  Dirk RAJ Demunck⁷  Brigitte van de Pas⁷  Jeroen MAM Retera⁸  Petra de Laat-Bierings⁸  Maria Braken⁹  Riet Eijsermans^1,10  Lucas MA Goossens^1,11  Maureen PMH Rutten-van Mölken^1,11 

[1] Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands;Department of Health Care Policy, Meander Group Zuid-Limburg, Heerlen, The Netherlands;Department of Respiratory Medicine, Alysis zorggroep Rijnstate Arnhem, Arnhem, The Netherlands;Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, The Netherlands;Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands;Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands;Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands;Department of Respiratory Medicine, Máxima Medical Centre, Veldhoven/Eindhoven, The Netherlands;Department of Respiratory Medicine, TweeSteden Hospital, Tilburg, The Netherlands;Department of Staff Nurses Nursing and Care, ZuidZorg, Veldhoven, The Netherlands;Department of Transmural Care, Thebe, Tilburg, The Netherlands;Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands;

关键词: Chronic Obstructive Pulmonary Disease;    Home Care;    Chronic Obstructive Pulmonary Disease Patient;    Informal Caregiver;    Minimal Clinical Important Difference;   

DOI  :  10.1186/1471-2458-10-618

 received in 2010-10-07, accepted in 2010-10-18,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundExacerbations of Chronic Obstructive Pulmonary Disease (COPD) are the main cause for hospitalisation. These hospitalisations result in a high pressure on hospital beds and high health care costs. Because of the increasing prevalence of COPD this will only become worse. Hospital at home is one of the alternatives that has been proved to be a safe alternative for hospitalisation in COPD. Most schemes are early assisted discharge schemes with specialised respiratory nurses providing care at home. Whether this type of service is cost-effective depends on the setting in which it is delivered and the way in which it is organised.Methods/DesignGO AHEAD (Assessment Of Going Home under Early Assisted Discharge) is a 3-months, randomised controlled, multi-centre clinical trial. Patients admitted to hospital for a COPD exacerbation are either discharged on the fourth day of admission and further treated at home, or receive usual inpatient hospital care. Home treatment is supervised by general nurses. Primary outcome is the effectiveness and cost effectiveness of an early assisted discharge intervention in comparison with usual inpatient hospital care for patients hospitalised with a COPD exacerbation. Secondary outcomes include effects on quality of life, primary informal caregiver burden and patient and primary caregiver satisfaction. Additionally, a discrete choice experiment is performed to provide insight in patient and informal caregiver preferences for different treatment characteristics. Measurements are performed on the first day of admission and 3 days, 7 days, 1 month and 3 months thereafter. Ethical approval has been obtained and the study has been registered.DiscussionThis article describes the study protocol of the GO AHEAD study. Early assisted discharge could be an effective and cost-effective method to reduce length of hospital stay in the Netherlands which is beneficial for patients and society. If effectiveness and cost-effectiveness can be proven, implementation in the Dutch health care system should be considered.Trial registrationNetherlands Trial Register NTR1129.

【 授权许可】

CC BY   
© Utens et al; licensee BioMed Central Ltd. 2010