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

Utens, Cecile M. A.; Goossens, Lucas M. A.; Smeenk, Frank W. J. M.; van Schayck, Onno C. P.; van Litsenburg, Walter; Janssen, Annet; van Vliet, Monique; Seezink, Wiel; Demunck, Dirk R. A. J.; van de Pas, Brigitte; de^Bruijn, Peter J.; van der Pouw, Anouschka; Retera, Jeroen M. A. M.; de Laat-Bierings, Petra; van Eijsden, Loes; Braken, Maria; Eijsermans, Riet; Mölken, Maureen P. M. H. Rutten-van
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p618
Academic Journal
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.


Related Articles

  • The Needs of Caregivers of People with COPD: A Study. Woolfe, Pamela; Margaret McMillan; Conway, Jane // Australian Journal of Primary Health;Apr2007, Vol. 13 Issue 1, p28 

    The purpose of this research was to replicate a study undertaken with different cohorts of clients and their caregivers in both Australia and the United States of America (USA). The researcher wanted to establish better local information, through the use of a survey, about the needs of informal...

  • Beta-blocker use and COPD mortality: a systematic review and meta-analysis. Etminan, Mahyar; Jafari, Siavash; Carleton, Bruce; FitzGerald, John Mark // BMC Pulmonary Medicine;2012, Vol. 12 Issue 1, p48 

    Background: Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial. Currently, no systematic review has examined the impact of beta-blockers on...

  • Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial. Lord, Victoria M.; Hume, Victoria J.; Kelly, Julia L.; Cave, Phoene; Silver, Judith; Waldman, Maya; White, Chris; Smith, Cayley; Tanner, Rebecca; Sanchez, Melissa; Man, William D-C.; Polkey, Michael I.; Hopkinson, Nicholas S. // BMC Pulmonary Medicine;2012, Vol. 12 Issue 1, p69 

    Background: There is some evidence that singing lessons may be of benefit to patients with chronic obstructive pulmonary disease (COPD). It is not clear how much of this benefit is specific to singing and how much relates to the classes being a group activity that addresses social isolation....

  • The ties that bind us: how existing relationships, health and gender shape family care in chronic obstructive pulmonary disease. Gullick, Janice G.; Stainton, M. Colleen // Nursing Reports;2012, Vol. 2 Issue 1, p31 

    Chronic obstructive pulmonary disease (COPD) changes family roles and relationship dynamics and the experience of the disease is influenced by family functioning. Merleau- Ponty's existential philosophy of the body provided the framework for this Heideggerian phenomenological inquiry. Fifteen...

  • Patients with COPD: do we fail them from beginning to end? Partridge, M.R. // Thorax;May2003, Vol. 58 Issue 5, p373 

    Editorial. Recognizes the burden of chronic obstructive pulmonary disease (COPD) to both the individual and the society. Development of a comprehensive approach for the prevention and control of respiratory disease; Importance of diagnosing COPD early in its natural history.

  • Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Mannino, D.M.; Buist, A.S.; Petty, T.L.; Enright, P.L.; Redd, S.C. // Thorax;May2003, Vol. 58 Issue 5, p388 

    Background: A study was undertaken to define the risk of death among a national cohort of US adults both with and without lung disease.Methods: Participants in the first National Health and Nutrition Examination Survey (NHANES I) followed for up to 22 years were...

  • Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD. Brusasco, V.; Hodder, R.; Miravitlles, M.; Korducki, L.; Towse, L.; Kesten, S. // Thorax;May2003, Vol. 58 Issue 5, p399 

    Background: A study was undertaken to record exacerbations and health resource use in patients with COPD during 6 months of treatment with tiotropium, salmeterol, or matching placebos.Methods: Patients with COPD were enrolled in two 6-month randomised, placebo...

  • COPD: Management of Acute Exacerbation and Chronic Stable Disease. Hunter, Melissa H.; King, Dana E. // American Family Physician;8/15/2001, Vol. 64 Issue 4, p603 

    Acute exacerbations of chronic obstructive pulmonary disease (COPD) are treated with oxygen (in hypoxemic patients), inhaled beta2 agonists, inhaled anticholinergics, antibiotics and systemic corticosteroids. Methylxanthine therapy may be considered in patients who do not respond to other...

  • End-stage COPD. Fernandes, Tanya // Nursing Standard;10/10/2012, Vol. 27 Issue 6, p58 

    A quiz on end stage chronic obstructive pulmonary disease is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics