title: Introduction of a breast cancer care programme including ultra short hospital stay in 4 early adopter centres: framework for an implementation study.
abstract: BACKGROUND
  Whereas ultra-short stay (day care or 24 hour hospitalisation) following breast cancer surgery was introduced in the US and Canada in the 1990s, it is not yet common practice in Europe. This paper describes the design of the MaDO study, which involves the implementation of ultra short stay admission for patients after breast cancer surgery, and evaluates whether the targets of the implementation strategy are reached. The ultra short stay programme and the applied implementation strategy will be evaluated from the economic perspective.
  
  
  METHODS
  The MaDO study is a pre-post-controlled multi-centre study, that is performed in four hospitals in the Netherlands. It includes a pre and post measuring period of six months each with six months of implementation in between in at least 40 patients per hospital per measurement period. Primary outcome measure is the percentage of patients treated in ultra short stay. Secondary endpoints are the percentage of patients treated according to protocol, degree of involvement of home care nursing, quality of care from the patient's perspective, cost-effectiveness of the ultra short stay programme and cost-effectiveness of the implementation strategy. Quality of care will be measured by the QUOTE-breast cancer instrument, cost-effectiveness of the ultra short stay programme will be measured by means of the EuroQol (administered at four time-points) and a cost book for patients. Cost-effectiveness analysis will be performed from a societal perspective. Cost-effectiveness of the implementation strategy will be measured by determination of the costs of implementation activities.
  
  
  CONCLUSIONS
  This study will reveal barriers and facilitators for implementation of the ultra short stay programme. Moreover, the results of the study will provide information about the cost-effectiveness of the ultra short stay programme and the implementation strategy.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN77253391.
authors.affiliation: Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. m.dekok@ah.unimaas.nl
authors.forename: Mascha
authors.initials: M
authors.lastname: de Kok
authors.forename: Caroline N A
authors.initials: CN
authors.lastname: Frotscher
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Alfons G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
authors.forename: Antoine V R J
authors.initials: AV
authors.lastname: Bell
authors.forename: Fred W
authors.initials: FW
authors.lastname: van der Ent
authors.forename: Maarten F
authors.initials: MF
authors.lastname: von Meyenfeldt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008875:Middle Aged; D009426:Netherlands; D011182:Postoperative Care / Q000191:economics*; D011788:Quality of Life; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome