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


METHODS
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.


CONCLUSIONS
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.


BACKGROUND
Current Controlled Trails ISRCTN58135104.
Heijnen
Ron W H
RW
Nursing Home Physician, Vivre Group, Polvertorenstraat 6, 6211 LX Maastricht, The Netherlands. R.heijnen@mumc.nl
Evers
Silvia M A A
SM
van der Weijden
Trudy D E M
TD
Limburg
Martien
M
Schols
Jos M G A
JM
D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D006761:Hospitals; D006801:Humans; D009426:Netherlands; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000191:economics*; D010360:Patient Transfer / Q000191:economics*; D012107:Research Design; D020521:Stroke / Q000191:economics / Q000628:therapy*; D013997:Time Factors