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Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Study protocol

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

Authors: Ron WH Heijnen, Silvia MAA Evers, Trudy DEM van der Weijden, Martien Limburg, Jos MGA Schols

Published in: BMC Public Health | Issue 1/2010

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Abstract

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/design

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.

Discussion

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.

Trial registration

Current Controlled Trails ISRCTN58135104
Appendix
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Literature
1.
go back to reference Struijs JN, van Genugten LL, Evers SMAA, Ament AJHA, Baan CA, Bos van den GAM: Modeling the Future Burden of Stroke in the Netherlands. Stroke. 2005, 36: 1648-1655. 10.1161/01.STR.0000173221.37568.d2.CrossRefPubMed Struijs JN, van Genugten LL, Evers SMAA, Ament AJHA, Baan CA, Bos van den GAM: Modeling the Future Burden of Stroke in the Netherlands. Stroke. 2005, 36: 1648-1655. 10.1161/01.STR.0000173221.37568.d2.CrossRefPubMed
2.
go back to reference Stroke Unit Trialists' Collaboration: Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews. 2007, CD000197-4 Stroke Unit Trialists' Collaboration: Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews. 2007, CD000197-4
3.
go back to reference Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Håheim LL: Treatment in a Combined Acute and Rehabilitation Stroke Unit: Which Aspects Are Most Important?. Stroke. 1999, 30: 917-923.CrossRefPubMed Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Håheim LL: Treatment in a Combined Acute and Rehabilitation Stroke Unit: Which Aspects Are Most Important?. Stroke. 1999, 30: 917-923.CrossRefPubMed
4.
go back to reference Hankey J, Warlow CP: Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations. The Lancet. 1999, 354: 1457-1463. 10.1016/S0140-6736(99)04407-4.CrossRef Hankey J, Warlow CP: Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations. The Lancet. 1999, 354: 1457-1463. 10.1016/S0140-6736(99)04407-4.CrossRef
5.
go back to reference Langhorne P, Taylor G, Murray G, Dennis M, Anderson C, Bautz-Holter E, Dey P, Indredavik B, Mayo N, Power M, Rodgers H, Ronning OM, Rudd A, Suwanwela N, Widen-Holmqvist L, Wolfe C: Early supported discharge services for stroke patients: a meta- analysis of individual patients' data. The Lancet. 2005, 365: 501-506.CrossRef Langhorne P, Taylor G, Murray G, Dennis M, Anderson C, Bautz-Holter E, Dey P, Indredavik B, Mayo N, Power M, Rodgers H, Ronning OM, Rudd A, Suwanwela N, Widen-Holmqvist L, Wolfe C: Early supported discharge services for stroke patients: a meta- analysis of individual patients' data. The Lancet. 2005, 365: 501-506.CrossRef
6.
go back to reference Kalra L, Langhorne P: Facilitating recovery: evidence for organized stroke care. J Rehabil Med. 2007, 39: 97-102. 10.2340/16501977-0043.CrossRefPubMed Kalra L, Langhorne P: Facilitating recovery: evidence for organized stroke care. J Rehabil Med. 2007, 39: 97-102. 10.2340/16501977-0043.CrossRefPubMed
7.
go back to reference Huijsman R, Klazinga NS, Scholte op Reimer WJM, Van Wijngaarden JDH, Van Exel NJA, Van Putte-Boon C, Prestholt FT, Koopmanschap MA, Niessen LW: Results of the EDISSE study of three regional experiments with stroke services. Report ZonMW. 2001 Huijsman R, Klazinga NS, Scholte op Reimer WJM, Van Wijngaarden JDH, Van Exel NJA, Van Putte-Boon C, Prestholt FT, Koopmanschap MA, Niessen LW: Results of the EDISSE study of three regional experiments with stroke services. Report ZonMW. 2001
8.
go back to reference Schols JMGA, Crebolder HFJM, Van Weel C: Nursing Home and Nursing Home Physician: The Dutch Experience. JAMDA. 2004, 5 (3): 207-212.PubMed Schols JMGA, Crebolder HFJM, Van Weel C: Nursing Home and Nursing Home Physician: The Dutch Experience. JAMDA. 2004, 5 (3): 207-212.PubMed
9.
go back to reference Landelijke Medische Registratie(PRISMANT), 2004. Landelijke Medische Registratie(PRISMANT), 2004.
10.
go back to reference Olsson BG, Sunnerhagen KS: Effects of day hospital rehabilitation after stroke. J Stroke Cerebrovasc Dis. 2006, 15 (3): 106-113. 10.1016/j.jstrokecerebrovasdis.2006.03.005.CrossRefPubMed Olsson BG, Sunnerhagen KS: Effects of day hospital rehabilitation after stroke. J Stroke Cerebrovasc Dis. 2006, 15 (3): 106-113. 10.1016/j.jstrokecerebrovasdis.2006.03.005.CrossRefPubMed
11.
go back to reference Dijks BP, Neyens JC, Schols JM, van Haastrecht JC, de Witt LP: Falss in nursing homes: on average almost two per bed per year, resulting in fracture in 1,3%. Ned Tijdschr Geneeskunde. 2005, 149 (19): 1043-1047. Dijks BP, Neyens JC, Schols JM, van Haastrecht JC, de Witt LP: Falss in nursing homes: on average almost two per bed per year, resulting in fracture in 1,3%. Ned Tijdschr Geneeskunde. 2005, 149 (19): 1043-1047.
12.
go back to reference van Straten A, de Haan RJ, Limburg M, Schuling J, Bossuyt PM, Bos van den GAM: A Stroke-Adapted 30 Item Version of the Sickness Impact Profile to Assess Quality of Life (SA-SIP30). Stroke. 1997, 28: 2155-2161.CrossRefPubMed van Straten A, de Haan RJ, Limburg M, Schuling J, Bossuyt PM, Bos van den GAM: A Stroke-Adapted 30 Item Version of the Sickness Impact Profile to Assess Quality of Life (SA-SIP30). Stroke. 1997, 28: 2155-2161.CrossRefPubMed
13.
go back to reference Mahoney FI, Barthel DW: Functional evaluation: the Barthel index. Maryland State Med J. 1965, 14: 61-65. Mahoney FI, Barthel DW: Functional evaluation: the Barthel index. Maryland State Med J. 1965, 14: 61-65.
14.
go back to reference de Haan RJ, Limburg M, Schuling J, Broeshart J, Jonkers L, van Zuylen P: Klinimetrische evaluatie van de Barthel Index, een maat voor beperkingen in het dagelijkse functioneren. Ned Tijdschr Geneeskd. 1993, 137 (18): 917-21.PubMed de Haan RJ, Limburg M, Schuling J, Broeshart J, Jonkers L, van Zuylen P: Klinimetrische evaluatie van de Barthel Index, een maat voor beperkingen in het dagelijkse functioneren. Ned Tijdschr Geneeskd. 1993, 137 (18): 917-21.PubMed
15.
go back to reference Schuling J, de Haan RJ, Limburg L, Groenier KH: The Frenchay Activities Index Assessment of Functional Status in Stroke Patients. Stroke. 1993, 24: 1173-1177.CrossRefPubMed Schuling J, de Haan RJ, Limburg L, Groenier KH: The Frenchay Activities Index Assessment of Functional Status in Stroke Patients. Stroke. 1993, 24: 1173-1177.CrossRefPubMed
16.
go back to reference van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988, 19: 604-607.CrossRefPubMed van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988, 19: 604-607.CrossRefPubMed
17.
go back to reference Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
18.
go back to reference van Heugten CM, Dekker J, Deelman BG, Stehmann-Saris FC, Kinebanian A: A diagnostic test for apraxia in stroke patients: internal consistency and diagnostic value. Clin Neuropsychol. 1999, 13 (2): 182-192.CrossRefPubMed van Heugten CM, Dekker J, Deelman BG, Stehmann-Saris FC, Kinebanian A: A diagnostic test for apraxia in stroke patients: internal consistency and diagnostic value. Clin Neuropsychol. 1999, 13 (2): 182-192.CrossRefPubMed
19.
go back to reference Halligan PW, Wilson B, Cockburn J: A short screening test for visual neglect in stroke patients. Int disabil Stud. 1990, 12 (3): 95-9.CrossRefPubMed Halligan PW, Wilson B, Cockburn J: A short screening test for visual neglect in stroke patients. Int disabil Stud. 1990, 12 (3): 95-9.CrossRefPubMed
20.
go back to reference Bjelland I, Dahl A, Haug T, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale. Journal of Psychosomatic Research. 2002, 52: 69-77. 10.1016/S0022-3999(01)00296-3.CrossRefPubMed Bjelland I, Dahl A, Haug T, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale. Journal of Psychosomatic Research. 2002, 52: 69-77. 10.1016/S0022-3999(01)00296-3.CrossRefPubMed
21.
go back to reference Boter H, de Haan RJ, Rinkel GJE: Clinimetric evaluation of a Satisfaction-with -Stroke-Care questionnaire. J Neurol. 2003, 250: 534-541. 10.1007/s00415-003-1031-2.CrossRefPubMed Boter H, de Haan RJ, Rinkel GJE: Clinimetric evaluation of a Satisfaction-with -Stroke-Care questionnaire. J Neurol. 2003, 250: 534-541. 10.1007/s00415-003-1031-2.CrossRefPubMed
22.
go back to reference Marchi S, Murphy JF, Rousseau P: Caring for the caregivers. J Gerontol Nurs. 1996, 22: 7-13.CrossRef Marchi S, Murphy JF, Rousseau P: Caring for the caregivers. J Gerontol Nurs. 1996, 22: 7-13.CrossRef
23.
go back to reference Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw CJ, Walker M: Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989, 20: 864-870.CrossRefPubMed Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw CJ, Walker M: Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989, 20: 864-870.CrossRefPubMed
24.
go back to reference The EuroQol Group: EuroQol a new facility for the measurement of health-related quality of life. Health Policy. 1990, 16 (3): 199-208. 10.1016/0168-8510(90)90421-9.CrossRef The EuroQol Group: EuroQol a new facility for the measurement of health-related quality of life. Health Policy. 1990, 16 (3): 199-208. 10.1016/0168-8510(90)90421-9.CrossRef
25.
go back to reference Dolan P: Modeling Valuations for EuroQol Health States. Med Care. 1997, 35 (11): 1095-1108. 10.1097/00005650-199711000-00002.CrossRefPubMed Dolan P: Modeling Valuations for EuroQol Health States. Med Care. 1997, 35 (11): 1095-1108. 10.1097/00005650-199711000-00002.CrossRefPubMed
26.
go back to reference Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, van Busschbach JJl: measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskunde. 2005, 149 (28): 1553-1555. Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, van Busschbach JJl: measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskunde. 2005, 149 (28): 1553-1555.
27.
go back to reference Brooks R,with the EuroQol Group: EuroQol: the current state of play. Health Policy. 1996, 37 (1): 53-72. 10.1016/0168-8510(96)00822-6.CrossRef Brooks R,with the EuroQol Group: EuroQol: the current state of play. Health Policy. 1996, 37 (1): 53-72. 10.1016/0168-8510(96)00822-6.CrossRef
28.
go back to reference Hakkaart-van Roijen L: Trimbos/iTMA questionnaire for costs associated with Psychiatric illness. 2002, Institute for Medical Technology Assessment Erasmus Universiteit Rotterdam Hakkaart-van Roijen L: Trimbos/iTMA questionnaire for costs associated with Psychiatric illness. 2002, Institute for Medical Technology Assessment Erasmus Universiteit Rotterdam
29.
go back to reference Koopmanschap MA: PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies. Expert Review of Pharmacoeconomics and Outcomes Research. 2005, 5 (1): 23-28. 10.1586/14737167.5.1.23.CrossRefPubMed Koopmanschap MA: PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies. Expert Review of Pharmacoeconomics and Outcomes Research. 2005, 5 (1): 23-28. 10.1586/14737167.5.1.23.CrossRefPubMed
30.
go back to reference Manca A, Hawkins N, Sculpher MJ: Estimating mean QALYs in trail-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 2005, 14 (5): 487-496. 10.1002/hec.944.CrossRefPubMed Manca A, Hawkins N, Sculpher MJ: Estimating mean QALYs in trail-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 2005, 14 (5): 487-496. 10.1002/hec.944.CrossRefPubMed
31.
32.
go back to reference Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. 2005, New York, Oxford University Press Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. 2005, New York, Oxford University Press
33.
go back to reference Oostenbrink JB, Koopmanschap MA, Rutten FFH: Standardisation of costs: the Dutch Manual for Costing in economic evaluations. Pharmacoeconomics. 2002, 20 (7): 443-454. 10.2165/00019053-200220070-00002.CrossRefPubMed Oostenbrink JB, Koopmanschap MA, Rutten FFH: Standardisation of costs: the Dutch Manual for Costing in economic evaluations. Pharmacoeconomics. 2002, 20 (7): 443-454. 10.2165/00019053-200220070-00002.CrossRefPubMed
34.
go back to reference Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FFH: Handleiding voor kostenonderzoek, methoden en standard kostprijzen voor economische evaluaties in de gezondheidszorg. Geactualiseerde versie 2004. College voor Zorgverzekeringen. 2004 Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FFH: Handleiding voor kostenonderzoek, methoden en standard kostprijzen voor economische evaluaties in de gezondheidszorg. Geactualiseerde versie 2004. College voor Zorgverzekeringen. 2004
35.
go back to reference College voor zorgverzekeringen: Farmacotherapeutisch Kompas (Pharmacotherapeutic Compass). College voor zorgverzekeringen. 2007 College voor zorgverzekeringen: Farmacotherapeutisch Kompas (Pharmacotherapeutic Compass). College voor zorgverzekeringen. 2007
36.
go back to reference Barber JA, Thompson SG: Analysis of cost data in randomised trails: an application of non-parametric bootstrap. Statist Med. 2000, 19: 3219-3236. 10.1002/1097-0258(20001215)19:23<3219::AID-SIM623>3.0.CO;2-P.CrossRef Barber JA, Thompson SG: Analysis of cost data in randomised trails: an application of non-parametric bootstrap. Statist Med. 2000, 19: 3219-3236. 10.1002/1097-0258(20001215)19:23<3219::AID-SIM623>3.0.CO;2-P.CrossRef
37.
go back to reference Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, Cook J, Glick H, Liljas B, Petitti D, Reed S: Good Research Practices for Cost-Effectiveness Analysis Alongside Clinical trials: The ISPOR RCT-CEA Task Force Report. Value in Health. 2005, 8 (5): 521-533. 10.1111/j.1524-4733.2005.00045.x.CrossRefPubMed Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, Cook J, Glick H, Liljas B, Petitti D, Reed S: Good Research Practices for Cost-Effectiveness Analysis Alongside Clinical trials: The ISPOR RCT-CEA Task Force Report. Value in Health. 2005, 8 (5): 521-533. 10.1111/j.1524-4733.2005.00045.x.CrossRefPubMed
38.
go back to reference Briggs AH, Wonderling DE, Mooney CZ: Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997, 6 (4): 327-340. 10.1002/(SICI)1099-1050(199707)6:4<327::AID-HEC282>3.0.CO;2-W.CrossRefPubMed Briggs AH, Wonderling DE, Mooney CZ: Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997, 6 (4): 327-340. 10.1002/(SICI)1099-1050(199707)6:4<327::AID-HEC282>3.0.CO;2-W.CrossRefPubMed
39.
go back to reference Hsiu HF, Shannon SE: Three Approaches to Qualitative Content Analysis. Qual Health Res. 2005, 15 (9): 1277-1288. 10.1177/1049732305276687.CrossRef Hsiu HF, Shannon SE: Three Approaches to Qualitative Content Analysis. Qual Health Res. 2005, 15 (9): 1277-1288. 10.1177/1049732305276687.CrossRef
Metadata
Title
The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study
Authors
Ron WH Heijnen
Silvia MAA Evers
Trudy DEM van der Weijden
Martien Limburg
Jos MGA Schols
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-279

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