Effectiveness and cost-effectiveness of early assisted discharge for chronic obstructive pulmonary disease exacerbations: the design of a randomised controlled trial.
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
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.


CONCLUSIONS
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.


BACKGROUND
Netherlands Trial Register NTR1129.
Utens
Cecile M A
CM
Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. cecile.utens@cze.nl
Goossens
Lucas M A
LM
Smeenk
Frank W J M
FW
van Schayck
Onno C P
OC
van Litsenburg
Walter
W
Janssen
Annet
A
van Vliet
Monique
M
Seezink
Wiel
W
Demunck
Dirk R A J
DR
van de Pas
Brigitte
B
de Bruijn
Peter J
PJ
van der Pouw
Anouschka
A
Retera
Jeroen M A M
JM
de Laat-Bierings
Petra
P
van Eijsden
Loes
L
Braken
Maria
M
Eijsermans
Riet
R
Rutten-van Mölken
Maureen P M H
MP
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006699:Home Care Services; D006801:Humans; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D010351:Patient Discharge / Q000191:economics* / Q000592:standards; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012107:Research Design; D018401:Sample Size; D011795:Surveys and Questionnaires