PRaCTICaL Trial

A Pragmatic Randomised Controlled Trial of Intensive Care post-discharge review clinics in improving Longer-term Outcomes from critical illness (PRaCTICaL Trial)

Of the 10,000 patients admitted to intensive care units in Scotland per year almost 5000 have died within one year of admission but even those who survive continue to experience severe physical and psychological problems for years. This represents a considerable degree of morbidity and a continuing financial burden for the NHS. Despite the lack of evidence, over 40 hospitals across the UK have developed intensive care post-discharge review clinics in an attempt to improve outcomes after ICU discharge. Using a pragmatic randomised controlled trial we sought to determine if such clinics are both effective and cost-effective. Outcome measures included physical and psychological health-related quality of life and morbidity. A formal economic evaluation was an integral part of this project. Cost effectiveness and cost-utility analysis were conducted including both deterministic and probabilistic sensitivity analysis.

Outcome and Translation

Of the 10,000 patients admitted to intensive care units in Scotland per year almost 5000 have died within one year of admission but even those who survive continue to experience severe physical and psychological problems for years. This represents a considerable degree of morbidity and a continuing financial burden for the NHS. Despite the lack of evidence, over 40 hospitals across the UK have developed intensive care post-discharge review clinics in an attempt to improve outcomes after ICU discharge. Using a pragmatic randomised controlled trial we sought to determine if such clinics are both effective and cost-effective. Outcome measures included physical and psychological health-related quality of life and morbidity. A formal economic evaluation was an integral part of this project. Cost effectiveness and cost-utility analysis were conducted including both deterministic and probabilistic sensitivity analysis.

HERU researchers involved in this research project: Luke Vale (HERU/HSRU) and Rodolfo Hernandez

External collaborators: M Johnston, M Campbell, J Norrie, C Pflanz-Sinclair, C Ramsay, A McDonald, G McPherson (HSRU, University of Aberdeen); B Cuthbertson (Sunnybrook Health Science Centre, Toronto); J Rattray, J Wildsmith (University of Dundee) and E Wilson (Ninewells Hospital, Dundee)

Publications

Cuthbertson, B., Rattray, J., Johnston, M., Wildsmith, J.A., Wilson, E., Hernández, R., Ramsey, C., Hull, A.M., Norrie, J. and Campbell, M. (2007) 'Study protocol: A Pragmatic Randomised, Controlled Trial of Intensive Care follow up programmes in improving Longer-term outcomes from critical illness. The PRACTICAL study', BMC Health Services Research, 7(116)

Cuthbertson, B.H., Rattray, J., Campbell, M.K., Gager, M., Roughton, S., Smith, A., Hull, A., Breeman, S., Norrie, J., Jenkinson, D., Hernández, R., Johnston, M., Wilson, E. and Waldmann, C. on behalf of the PRaCTICaL study group (2009) 'The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial', British Medical Journal, 339, b3723

Cuthbertson, B.H., Rattray, J., Campbell, M.K., Gager, M., Roughton, S., Smith, A., Hull, A., Norrie, J., Jenkinson, D., Hernández, R., Johnston, M., Wilson, E. and Waldmann, C. on behalf of the PRaCTICaL study group. (2009) A Pragmatic Randomised Controlled Trial of Intensive Care post-discharge review clinics in improving Longer-term outcomes from critical illness. The PRaCTICaL trial, Report commissioned by the Chief Scientist Office.

Hernández, R. A., Jenkinson, D., Vale, L. and Cuthbertson, B.H. (2014) 'Economic evaluation of nurse-led intensive care follow-up programmes compared with standard care: the PRaCTICaL trial', European Journal of Health Economics, 15(3), 243-252

Presentations

Hernández, R. and Cuthbertson, B.H. (2009) 'PRaCTICaL Trial: cost-effectiveness analysis of Intensive Care post-discharge review clinics', 6th Annual Meeting of the Health Technology Assessment International (HTAi), Singapore, June 2009.PRACTICAL

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