Background. Short stay (admission, surgery, and discharge the same day or within 24 hours) following breast cancer surgery is part of an established care protocol but as yet not well implemented in... Show moreBackground. Short stay (admission, surgery, and discharge the same day or within 24 hours) following breast cancer surgery is part of an established care protocol but as yet not well implemented in Europe. Alongside a before-after multi-centre implementation study, an economic evaluation was performed exploring the cost-effectiveness of a short stay programme (SSP) versus care as usual (CAU). Material and methods. In the implementation study, 324 patients were included. In the economic evaluation a societal perspective was applied with a six week time horizon. Cost data were obtained from Case Record Forms and cost diaries. Effectiveness was assessed by calculating Quality Adjusted Life Years (QALYs), using the EuroQol-5D. Cost-effectiveness was expressed as the incremental costs per QALY. Results. Mean societal costs decreased by (sic)955,- (95% CI (sic) - 2104,- to (sic)157,-) for patients in SSP (n=127) compared with CAU (n=135). Mean healthcare costs differed (sic)883,- (95% CI (sic) - 1560,- to (sic)-870,-) in favour of SSP. The incremental cost-effectiveness ratio could not be calculated due to similar effectiveness for both groups, i.e. the difference in QALYs was zero. The cost-effectiveness acceptability curves showed that the probability that SSP was more cost-effective than CAU was over 90% in the base-case analysis. Discussion. A short stay programme as implemented is cost-effective compared with care as usual. In achieving good and more efficient quality of care, larger scale implementation is warranted. Show less
Kok, M. de; Weijden, T. van der; Kessels, A.G.H.; Dirksen, C.D.; Sixma, H.J.M.; Velde, C.J.H. van de; ... ; Meyenfeldt, M.F. von 2010
Purpose: To assess breast cancer patients' opinions on quality of care during an implementation study on short hospital stay, and to formulate patient inspired targets for further quality... Show morePurpose: To assess breast cancer patients' opinions on quality of care during an implementation study on short hospital stay, and to formulate patient inspired targets for further quality improvement based on results of the QUOTE (Quality of Care Through the Patients' Eyes) breast cancer instrument. Results: Quality of patient education regarding activities at home was in need of improvement in both measurements. Quality of services delivered by the surgeon improved somewhat after implementation. Although quality of waiting and process times improved after implementation, there was still room for further improvement on these aspects. Conclusion: A breast cancer care programme in short stay was introduced while, on average, preserving quality of care as perceived by the patient. However, aspects regarding education on drains, prosthesis, exercises after surgery, survival rates, and waiting and process times require continuing attention to enhance patients' assessment of quality of care. (C) 2010 Elsevier Ltd. All rights reserved. Show less
Kok, M. de; Weijden, T. van der; Kessels, A.G.H.; Dirksen, C.D.; Roukema, J.A.; Ent, F.W.C. van der; ... ; Meyenfeldt, M.F. von 2010
Background: Short-stay breast cancer surgery (24 h or day case) is not common practice in Europe. This before-after comparative study was carried out to test the feasibility of systematically... Show moreBackground: Short-stay breast cancer surgery (24 h or day case) is not common practice in Europe. This before-after comparative study was carried out to test the feasibility of systematically implementing a care programme incorporating short-stay admission using strategies tailored to individual hospital needs, and to assess safety and facilitating factors. Methods: Patients with breast cancer from four Dutch hospitals participated. The intervention concerned the programme developed by the Maastricht University Medical Centre. This was implemented through local multidisciplinary meetings and educational outreach visits. Results: Of 421 eligible patients, 324 (77.0 percent) gave consent to participate. The proportion of patients who had short-stay treatment increased from 45.3 per cent before to 82.2 per cent after implementation of the programme (P < 0.001). No increase was observed in the rate of complications, readmissions, reoperations or number of visits to the emergency department. Factors associated with an increased chance of short-stay treatment were: breast-conserving surgery, having children and being employed. Being aged over 64 years showed a trend towards a decreased chance. Conclusion: Introducing a care programme incorporating short stay following breast cancer surgery in four hospitals was feasible and safe. Show less
