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Effectiveness and cost-effectiveness of early assisted discharge for chronic obstructive pulmonary disease exacerbations: the design of a randomised controlled trial.

Utens CM, Goossens LM, Smeenk FW, van Schayck OC, van Litsenburg W, Janssen A, van Vliet M, Seezink W, Demunck DR, van de Pas B, de Bruijn PJ, van der Pouw A, Retera JM, de Laat-Bierings P, van Eijsden L, Braken M, Eijsermans R, Rutten-van Mölken MP - BMC Public Health (2010)

Bottom Line: Secondary outcomes include effects on quality of life, primary informal caregiver burden and patient and primary caregiver satisfaction.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. cecile.utens@cze.nl

ABSTRACT

Background: Exacerbations 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/design: GO 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.

Discussion: This 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 registration: Netherlands Trial Register NTR1129.

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Related in: MedlinePlus

Study design.
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Figure 1: Study design.

Mentions: The GO AHEAD study is a randomised controlled, multi-centre trial comparing two management strategies for patients admitted to the hospital for a COPD exacerbation. The intervention strategy is early assisted discharge, which implies that patients are discharged early from hospital with a package of home care. Recovery is monitored while patients are further treated at home. This management strategy is compared to usual hospital care, where patients remain hospitalised and are monitored in hospital. The total length of the active, supervised treatment phase for both groups is planned to be seven days. The follow up period of the trial is three months. Figure 1 gives a complete overview of the study design. Main focus of the study is not only to perform an effect evaluation, but also a cost evaluation and a discrete choice experiment. This trial was approved by the Medical Ethics Committee of the Catharina-hospital Eindhoven, the Netherlands and this approval was reconfirmed by the Medical Ethics Committees of the other participating hospitals.


Effectiveness and cost-effectiveness of early assisted discharge for chronic obstructive pulmonary disease exacerbations: the design of a randomised controlled trial.

Utens CM, Goossens LM, Smeenk FW, van Schayck OC, van Litsenburg W, Janssen A, van Vliet M, Seezink W, Demunck DR, van de Pas B, de Bruijn PJ, van der Pouw A, Retera JM, de Laat-Bierings P, van Eijsden L, Braken M, Eijsermans R, Rutten-van Mölken MP - BMC Public Health (2010)

Study design.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2965725&req=5

Figure 1: Study design.
Mentions: The GO AHEAD study is a randomised controlled, multi-centre trial comparing two management strategies for patients admitted to the hospital for a COPD exacerbation. The intervention strategy is early assisted discharge, which implies that patients are discharged early from hospital with a package of home care. Recovery is monitored while patients are further treated at home. This management strategy is compared to usual hospital care, where patients remain hospitalised and are monitored in hospital. The total length of the active, supervised treatment phase for both groups is planned to be seven days. The follow up period of the trial is three months. Figure 1 gives a complete overview of the study design. Main focus of the study is not only to perform an effect evaluation, but also a cost evaluation and a discrete choice experiment. This trial was approved by the Medical Ethics Committee of the Catharina-hospital Eindhoven, the Netherlands and this approval was reconfirmed by the Medical Ethics Committees of the other participating hospitals.

Bottom Line: Secondary outcomes include effects on quality of life, primary informal caregiver burden and patient and primary caregiver satisfaction.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. cecile.utens@cze.nl

ABSTRACT

Background: Exacerbations 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/design: GO 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.

Discussion: This 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 registration: Netherlands Trial Register NTR1129.

Show MeSH
Related in: MedlinePlus