Open Access Study protocol

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

Cecile MA Utens13*, Lucas MA Goossens2, Frank WJM Smeenk1, Onno CP van Schayck3, Walter van Litsenburg1, Annet Janssen1, Monique van Vliet4, Wiel Seezink4, Dirk RAJ Demunck5, Brigitte van de Pas5, Peter J de Bruijn6, Anouschka van der Pouw6, Jeroen MAM Retera7, Petra de Laat-Bierings7, Loes van Eijsden8, Maria Braken9, Riet Eijsermans10 and Maureen PMH Rutten-van Mölken2

Author Affiliations

1 Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands

2 Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands

3 Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands

4 Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, the Netherlands

5 Department of Respiratory Medicine, Máxima Medical Centre, Veldhoven/Eindhoven, the Netherlands

6 Department of Respiratory Medicine, Alysis zorggroep Rijnstate Arnhem, Arnhem, the Netherlands

7 Department of Respiratory Medicine, TweeSteden Hospital, Tilburg, the Netherlands

8 Department of Health Care Policy, Meander Group Zuid-Limburg, Heerlen, the Netherlands

9 Department of Staff Nurses Nursing and Care, ZuidZorg, Veldhoven, the Netherlands

10 Department of Transmural Care, Thebe, Tilburg, the Netherlands

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BMC Public Health 2010, 10:618  doi:10.1186/1471-2458-10-618

Published: 18 October 2010

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.