Open Access Study protocol

The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study

Ron WH Heijnen1*, Silvia MAA Evers2, Trudy DEM van der Weijden3, Martien Limburg4 and Jos MGA Schols15

Author Affiliations

1 Nursing Home Physician, Vivre Group, Polvertorenstraat 6, 6211 LX Maastricht, The Netherlands

2 School of CAPHRI/Department of Health Organisation Policy and Economics, Maastricht University, Maastricht, The Netherlands

3 School of CAPHRI/Department of General Practice, Maastricht University, Maastricht, The Netherlands

4 Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands

5 School of CAPHRI/Department of General Practice/Nursing Home Medicine, Maastricht University, Maastricht, The Netherlands

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BMC Public Health 2010, 10:279  doi:10.1186/1471-2458-10-279

Published: 26 May 2010



As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients.

The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation.


The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals.


The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article.

Trial registration

Current Controlled Trails ISRCTN58135104