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

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BMC Public Health

, 10:618

First Online: 18 October 2010Received: 07 October 2010Accepted: 18 October 2010DOI: 10.1186-1471-2458-10-618

Cite this article as: Utens, C.M., Goossens, L.M., Smeenk, F.W. et al. BMC Public Health 2010 10: 618. doi:10.1186-1471-2458-10-618


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.

AbbreviationsBCaBias Correction and acceleration

Body Mass Indexbody weight in kilogram-body height in meters

CCICharlson Comorbidity Index

CCQClinical COPD Questionnaire

CE-planeCost-Effectiveness plane

COPDChronic Obstructive Pulmonary Disease

CRPC-reactive protein

DCEDiscrete Choice Experiment


FEV1Forced Expiratory Volume in one second

FVCForced Vital Capacity

ICERIncremental Cost-Effectiveness Ratios

MCIDMinimal Clinical Important Difference

Pack Year PYnumber of cigarettes smoked per day × number of years smoking-20

QALYQuality Adjusted Life Years

RCTrandomised controlled trial

WTPwillingness to pay.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-618 contains supplementary material, which is available to authorized users.

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Autor: Cecile MA Utens - Lucas MA Goossens - Frank WJM Smeenk - Onno CP van Schayck - Walter van Litsenburg - Annet Janssen - M

Fuente: https://link.springer.com/

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