Hospitalización domiciliaria para el alta temprana
Referencias
Referencias de los estudios incluidos en esta revisión
Referencias de los estudios excluidos de esta revisión
Referencias de los estudios en curso
Referencias adicionales
Referencias de otras versiones publicadas de esta revisión
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients following elective surgery (hernia and varicose veins) Age: 18 to 64 years N = 224 (T: 117; C: 107) (in 27 months) | |
| Interventions | Hospital at home (early discharge) Type of service: early discharge from hospital; no night care; organised by hospital surgeons, provided by community; clinical responsibility held by GP Skill mix and size of HAH teams: 21 home helps; 52 district nurses. No dedicated staff Control group: inpatient hospital care Study dates: January 1971 to March 1973 | |
| Outcomes | Clinical complications; patient satisfaction; caregiver satisfaction Outcomes measured at: 7 days; 6 weeks; 2 to 3 years for recurrence | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not reported |
| Allocation concealment (selection bias) | Unclear risk | Method not reported |
| Baseline outcome measurements (selection bias) | Unclear risk | Baseline outcome measurements not reported |
| Baseline characteristics (selection bias) | High risk | Baseline characteristics not reported |
| Blinding (performance bias and detection bias) | Unclear risk | Clinical complications reported by consulting surgeons, nurses or general practitioners |
| Blinding (performance bias and detection bias) | Unclear risk | Patient‐reported satisfaction with health care |
| Incomplete outcome data (attrition bias) | Low risk | 83% follow‐up data |
| Selective reporting (reporting bias) | Unclear risk | Not clear |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Australia Patients recovering from a stroke Mean age (SD): T: 72 years (11); C: 71 (11) N = 86 (T: 42; C: 44) | |
| Interventions | Early discharge hospital at home Type of service: specialist rehabilitation nurses; therapy sessions in patient's home and individually tailored to achieve mutually agreed goals over several weeks. Emphasis on self‐learning; adjustment to disability and structured practice sessions were encouraged between sessions Occupational therapy, physiotherapy, speech therapy Control group: inpatient hospital care Study dates: February 1997 to June 1998 | |
| Outcomes | Main outcome: self‐reported health status Other outcomes: mortality; functional status; quality of life; satisfaction; readmissions; length of stay Follow‐up: 1, 3, 6, and 12 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated allocation sequence |
| Allocation concealment (selection bias) | Low risk | Sealed opaque envelopes, done by different department |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for self‐reported health status and functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission and length of stay |
| Blinding (performance bias and detection bias) | Low risk | Outcome assessor blinded to allocation collected data on patient‐reported outcomes |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate < 5%, similar for both groups |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Norway Patients recovering from a stroke Mean age: T: 76.9; C: 76.3 N = 62 (T: 31; C: 31) | |
| Interventions | Early discharge outreach Type of service: physiotherapy, occupational therapy and dedicated nursing; stroke unit + home‐based programme of follow‐up care + primary health care. Home visit if patient lives within 30 to 45 minute radius of hospital; if greater than this the primary health team visited the home. Follow‐up plan made with family and primary healthcare providers. Mobile team established a service and support system. Meeting with physician and stroke team + patient and family on the day of discharge to define follow‐up care plans. For patients with extensive deficits plans for further rehabilitation were made. Once home contact was maintained by phone + at least 1 other home visit. Follow‐up by mobile team terminated with an out‐patient consultation (for those living within 30 to 40 minutes away from the hospital) or home visit (if more than 35 to 40 minutes). Local information meeting if a group of recruited patients lived in the same area. Control group: inpatient hospital care Study dates: June 1999 to June 2001 | |
| Outcomes | Main outcome: functional status Other outcomes: mortality; readmission; health status; caregiver views; length of stay Follow‐up: 6, 26 and 52 weeks | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Block randomisation, order of blocks randomly chosen |
| Allocation concealment (selection bias) | Low risk | Sealed opaque envelopes; procedure done externally |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission and length of stay |
| Blinding (performance bias and detection bias) | Low risk | Outcome assessor blinded to allocation |
| Incomplete outcome data (attrition bias) | Low risk | All patients accounted for; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Norway Recovering from a stroke Median age (IQR): T: 79.5 (69 to 84); C: 78 (74 to 82) N = 82 (Tt: 42; C: 40) | |
| Interventions | Early discharge, hospital outreach community‐based rehabilitation Type of service: multidisciplinary hospital‐based team (1 nurse, 1 occupational therapist, 1 physiotherapist) plus community nurses Control group: inpatient hospital care Study dates: June 1997 to January 1999 | |
| Outcomes | Main outcome: functional ability Other outcomes: mortality; psychological well‐being; place of residence; readmissions; length of stay Follow‐up: 3 and 6 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Block randomisation by computer‐generated random numbers |
| Allocation concealment (selection bias) | Low risk | Allocation done using sealed envelopes opened once a new participant was included |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional ability; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, place of residence, readmission and length of stay |
| Blinding (performance bias and detection bias) | Low risk | Outcome assessor blinded to allocation |
| Incomplete outcome data (attrition bias) | Low risk | Similar proportion of attrition in both groups; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients with ischaemic heart disease, first time isolated bypass surgery Age: no data N = 97 (T: 65; C: 32) | |
| Interventions | Early discharge outreach Type of service: specialist hospital‐based nurses with enhanced preoperative preparation and planned early discharge with specialist home care at 4 (± 1) days after surgery. Admission to hospital on the day of surgery Control group: inpatient hospital care Study dates: not reported | |
| Outcomes | Main outcomes: length of hospital stay, in‐hospital clinical events, total costs, readmission, quality of life Follow‐up: 12 weeks | |
| Notes | Had to have a caregiver available | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not reported |
| Allocation concealment (selection bias) | Unclear risk | Method not reported |
| Baseline outcome measurements (selection bias) | Unclear risk | Baseline outcome measurements not reported |
| Baseline characteristics (selection bias) | High risk | Baseline characteristics not reported |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for readmission, length of stay and total costs |
| Blinding (performance bias and detection bias) | Unclear risk | Unclear risk for patient‐reported measures of outcome |
| Incomplete outcome data (attrition bias) | Unclear risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | Not clear |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Australia Elderly patients whose length of hospital stay exceeded 6 days, who were referred for geriatric rehabilitation and expected to return home and live reasonably independently Mean age (SD): T: 83.86 (7.8); C: 84.0 (7.02) N = 104 (T: 70; C: 34) Study dates: April 2000 to October 2002 | |
| Interventions | Early discharge hospital‐based outreach Type of service: nurses, physiotherapy, occupational therapy, physician Control group: inpatient hospital care | |
| Outcomes | Main outcome: delirium Other outcomes: mortality; functional and cognitive status; psychological well‐being; satisfaction; readmission; length of stay; cost Follow‐up: 1 month and 6 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random numbers using opaque envelopes using a 2:1 distribution |
| Allocation concealment (selection bias) | Low risk | Enrolment assessment done prior to patient allocation |
| Baseline outcome measurements (selection bias) | High risk | Baseline outcome measurements done prior to intervention for functional and cognitive status and psychological well‐being; participants allocated to treatment group were more independent |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission, length of stay and cost |
| Blinding (performance bias and detection bias) | Unclear risk | Baseline assessment done blindly; follow‐up assessments unblinded |
| Incomplete outcome data (attrition bias) | Low risk | All patients accounted for; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients with COPD, recruited from medical wards Mean age (SD): T: 65.7 (1.6); C: 68 (1.2) N = 81 (T: 41; C: 40) | |
| Interventions | Hospital at home (early discharge) Type of service: emergency admissions recruited from the ward (early discharge within 3 days of readmission) respiratory nurse (did not prescribe), GP provided out‐of‐hours medical care Control group: inpatient hospital care Study dates: not reported (conducted over 14 months) | |
| Outcomes | Main outcomes: readmission; hospital length of stay; mortality Follow‐up: 60 days | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Treatment allocation schedule generated by random numbers |
| Allocation concealment (selection bias) | Low risk | Non‐clinical member of staff based remotely |
| Baseline outcome measurements (selection bias) | Low risk | Baseline measures of the main outcomes of readmission, length of stay and mortality at follow‐up were not relevant |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcome measures ascertained from clinical records |
| Blinding (performance bias and detection bias) | Low risk | All outcomes are objective |
| Incomplete outcome data (attrition bias) | Low risk | Retention rate > 90%; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Australia (3 metropolitan hospitals, Adelaide) Patients with a hip fracture, excluded from participating if they did not have a telephone at home or had inadequate social support Median age (IQR): T: 81.6 (78.2 ‐ 85.4); C: 83.5 (76.6 ‐ 85.5) N = 66 (T: 34; C: 32) | |
| Interventions | Hospital at home (early discharge) Type of service: rehabilitation: physiotherapy, occupational therapy, speech therapist, social worker, therapy aid, nursing care, and assistance with shopping and cleaning; based on short‐term treatment goals negotiated with patient and caregiver. Therapy adapted to rate of patient's progress Control group: inpatient hospital care Study dates: July 1998 to July 1999 | |
| Outcomes | Mobility; physical function; health‐related quality of life; adverse events; patient and caregiver satisfaction; caregiver strain; length of stay Follow‐up: 4 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random sequence |
| Allocation concealment (selection bias) | Low risk | Randomisation by a hospital pharmacist independent of the study |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for physical functioning; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcome for length of stay |
| Blinding (performance bias and detection bias) | Low risk | Outcome assessor blinded to allocation |
| Incomplete outcome data (attrition bias) | Unclear risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | Not clear |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK (Nottingham) 3 most common conditions were fractures (105/370, 28%), neurological conditions, mainly stroke (97/370, 26%), cardio‐respiratory illnesses (50/370,14%); 247/370 (66%) lived alone. Median age (IQR): T: 80 years (73 ‐ 85); C: 79 (72 ‐ 86) N = 370 (T: 185; C: 185) | |
| Interventions | Hospital at home (early discharge) Type of service: provided by community services, GP had clinical responsibility, physiotherapy, occupational therapy, 3 dedicated nurses plus 7 rehabilitation assistants, provided care up to 4 weeks Community care officer liaised with social services Control group: inpatient hospital care Study dates: July 1999 to July 2000 | |
| Outcomes | Mortality; readmission; functional ability; quality of life; psychological well‐being (patient and caregiver); cost Follow‐up: 3 months and 12 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated balanced randomisation within strata |
| Allocation concealment (selection bias) | Low risk | Done remotely by independent staff |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional ability and days in hospital; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission and cost |
| Blinding (performance bias and detection bias) | Low risk | Participants completed assessment on their own; incomplete data were completed by blinded assessor |
| Incomplete outcome data (attrition bias) | Low risk | Low attrition rate and similar between groups; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Spain Diagnosis of COPD with a non‐specific worsening requiring hospital admission Mean age: T: 66 (SD 9); C: 66 (SD 9) N = 40 (T: 20; C; 20) | |
| Interventions | Early discharge hospital‐based outreach Type of service: all patients were assessed at 72 hours post‐admission and eligible patients were transferred home and received a same‐day visit by a specialist doctor (pulmonologist) and a nurse, who drew up a therapeutic plan; specialist did 2 additional visits, nurse visited every 12 hours and was responsible for general care of the patient, including health status assessment, medication intake, additional tests and health education. 24/7 care available from hospital phone number Control group: inpatient hospital care Study dates: not reported | |
| Outcomes | Main outcome: number of therapeutic failures (Treatment: readmission; C: ICU admission, clinical deterioration, infections, other complications) Other outcomes: referrals; relapse; smoking behaviour; length of stay Follow‐up: 1 month | |
| Notes | Potential conflict of interest as the study was funded by a commercial company that produces oxygen; staff from this commercial company also authored the paper | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not reported |
| Allocation concealment (selection bias) | Unclear risk | Method not reported |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for clinical characteristics and smoking behaviour; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective main outcome, ascertained from clinical records |
| Blinding (performance bias and detection bias) | Unclear risk | Unclear whether data collection was performed by blind assessor |
| Incomplete outcome data (attrition bias) | Low risk | All participants accounted for |
| Selective reporting (reporting bias) | High risk | Length of stay not stated as an outcome in Methods but reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Elderly medical patients Age: 76 to 90 years Number of patients in 5 months: T = 30; C = 30 | |
| Interventions | Type of scheme: early discharge; not clear if 24‐hour care provided; time limit of 6 weeks Type of service: organised by hospital, provided by community; GP provided routine and emergency care Skill mix: 1 nurse manager, 1 physiotherapist, 1 occupational therapist, 3 assistants (part‐time) Control group: inpatient hospital care Study dates: not reported (conducted over 5 months) | |
| Outcomes | Main outcomes: length of stay; place of residence; use of other health services Other outcomes: mortality; functional status; psychological well‐being Follow‐up: 4 weeks, 12 weeks, 26 weeks | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not described |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status and psychological well‐being; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, place of residence, length of stay and use of other health services |
| Blinding (performance bias and detection bias) | Unclear risk | Outcome assessor not blinded to group allocation |
| Incomplete outcome data (attrition bias) | Low risk | All patients accounted for |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK (Belfast) Recovering from a stroke Median age: T: 68; C: 71 N = 113 (T: 59; C: 54) | |
| Interventions | Early discharge community‐based Type of service: average of 2½ home visits a week for 3 months, each visit lasting 45 minutes Multidisciplinary meetings held to discuss the assessment of patients and progress towards rehabilitation goals, which were set by relatives, patient and therapist. Patients discharged to home following home assessment and placement of aids and equipment. Physiotherapist, occupational therapist, nurses, speech therapist Control group: inpatient hospital care Study dates: not reported (conducted over 2 years) | |
| Outcomes | Mortality; readmission; functional status; quality of life; satisfaction; caregiver burden; length of stay; cost Follow‐up: 6 months and 12 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomly‐assigned allocation |
| Allocation concealment (selection bias) | Low risk | Done and managed independently by statistician and secretary |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status, quality of life and satisfaction; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission, length of stay and cost |
| Blinding (performance bias and detection bias) | Low risk | Baseline assessment done blindly; remaining assessments done unblinded |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate <10% and similar for both groups; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: New Zealand In hospital for less than 36 hours in the emergency department of acute assessment ward (admission avoidance), or admitted and with help of hospital at home services could be discharged home earlier than would otherwise have been the case (early discharge). Patients had a broad range of diagnoses: fractures (28%); miscellaneous medical problems (18%); respiratory problems (16%); stroke and neurological diagnoses (14%); falls and injuries (11%); cardiac diagnoses (8%); and rehabilitation and other problems (5%) Mean age: 80 years N = 285 (T: 143; C: 142) | |
| Interventions | Early discharge hospital based outreach Type of service: co‐ordinated rehabilitation multidisciplinary team (physiotherapy, occupational therapy, social care, nursing) Study dates: not reported | |
| Outcomes | Main outcomes: functional status; cognitive status Other outcomes: mortality; readmission; quality of life; satisfaction; caregiver burden; length of stay; cost Follow‐up: 10 days, 30 days, and 90 days | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomisation service |
| Allocation concealment (selection bias) | Low risk | Independent from research team |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional and cognitive status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission, length of stay and cost |
| Blinding (performance bias and detection bias) | Low risk | Unblinded assessment; assessor not involved in the provision of care |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate < 5% and similar for both groups; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Turkey Diagnosis of acute non‐alcoholic pancreatitis presenting to hospital within 48 hours of symptom onset Mean age: T: 55 (SD 16); C: 54 (SD 20) N = 84 (T: 42; C; 42) | |
| Interventions | Early discharge hospital‐based outreach Type of service: all patients were assessed at < 24 hours post‐admission and eligible patients were transferred home with an intravenous port and visited on 2nd, 3rd, and 5th days by a staff nurse; another nurse visited every 12 hours and was responsible for general care of the patient, including vital signs and symptoms. 24/7 care available from physician (phone number provided) Control group: inpatient hospital care Study dates: November 2011 to May 2012 | |
| Outcomes | Main outcome: time to resolution of abdominal pain Other outcomes: 30‐day readmission rate; time to resumption of oral solid food; cost Follow‐up: 30 days | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation was performed by a computer programme (RANDOM.ORG, Dublin, Ireland) |
| Allocation concealment (selection bias) | Unclear risk | Method not described |
| Baseline outcome measurements (selection bias) | Low risk | Baseline measures of the main outcomes of pain, cost and readmission at follow‐up were not relevant |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar for all main characteristics |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for readmission and cost |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported who performed the follow‐up assessment and main outcome is subjective (pain resolution) |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up |
| Selective reporting (reporting bias) | High risk | Main outcome changed between trial registry and publication (clinicaltrials.gov/ct2/show/NCT01796652); when registered, main outcome reported as 30‐day readmission rates |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Norway Patients recovering from a stroke Mean age: T: 74; C: 73.8 N = 320 (T: 160; C: 160) | |
| Interventions | Hospital at home (early discharge) Type of service: mobile team based in a stroke unit and working with primary care team Skill mix: nurse, physiotherapist, occupational therapist, stroke physician Control group: combined active and rehabilitation stroke unit and further follow‐up organised by rehabilitation clinic and/or primary healthcare system Study dates: March 1995 to March 1997 | |
| Outcomes | Mortality; functional status; place of residence; hospital length of stay Fwollo‐up: 6 weeks and 26 weeks | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not described |
| Allocation concealment (selection bias) | Unclear risk | Method not described |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for length of stay and place of residence |
| Blinding (performance bias and detection bias) | Low risk | Outcome assessor blinded to allocation |
| Incomplete outcome data (attrition bias) | Low risk | No losses to follow‐up |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Single‐blind randomised trial with parallel assignment | |
| Participants | Location: Sweden Patients aged ≥ 70 years hospitalised for acute hip fracture surgery Age: mean (SD): 83 years (6.7) N = 205 (T: 107; C: 98) | |
| Interventions | Geriatric Interdisciplinary Home Rehabilitation (GIHR); the team was supervised by a geriatrician and included nursing, occupational therapy, physiotherapy, with social work and dietary advice also available if necessary. Number of home visits and rehabilitation programme was tailored to the patient's needs Comparison: conventional care and rehabilitation in the geriatric ward Study dates: May 2008 to June 2011 | |
| Outcomes | Main outcomes: walking ability indoors and outdoors; use of walking device; gait speed. Length of stay and mortality also reported Follow‐up: 3 months and 12 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Sequentially‐numbered lots in opaque, sealed envelopes |
| Allocation concealment (selection bias) | Low risk | Nurse at the ward, not involved in the study |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional performance (including walking ability) prior to fracture; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective measures (length of stay; mortality) |
| Blinding (performance bias and detection bias) | Low risk | Assessments in hospital took place in a neutral room at the ward in order to keep the assessors blinded to group allocation and they had no other contact with the geriatric ward or access to patients’ medical records during the study period |
| Incomplete outcome data (attrition bias) | Low risk | Attrition at 12 months of 6% (intervention group) and 3% (control group) |
| Selective reporting (reporting bias) | High risk | Trial registration includes 13 outcomes, including 6 primary outcomes, of which only 1 is reported (www.isrctn.com/ISRCTN15738119) |
| Study characteristics | ||
| Methods | Randomised trial No details on Methods | |
| Participants | Location: UK Patients recovering from a stroke | |
| Interventions | Hospital at home (early discharge) | |
| Outcomes | Mortality | |
| Notes | Unpublished | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported, unpublished data |
| Allocation concealment (selection bias) | Unclear risk | Not reported, unpublished data |
| Baseline outcome measurements (selection bias) | Unclear risk | Not reported, unpublished data |
| Baseline characteristics (selection bias) | Unclear risk | Not reported, unpublished data |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported, unpublished data |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported, unpublished data |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported, unpublished data |
| Selective reporting (reporting bias) | Unclear risk | Not reported, unpublished data |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Elderly medical patients Mean age: 81.5 years | |
| Interventions | Hospital at home (early discharge) Type of service: hospital‐based; GP has clinical responsibility; no night care Skill mix of HAH team: 1 nurse manager; 10 unqualified staff Control group: inpatient hospital care Study dates: June 1989 to February 1990 | |
| Outcomes | Main outcomes: place of residence; readmission Other outcomes: mortality; functional status; psychological well‐being; cognitive status; use of other health services Follow‐up: 6 weeks, 12 weeks, and 12 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not described |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional and cognitive status and psychological well‐being; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar for main characteristics |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission, place of residence, and use of other health services |
| Blinding (performance bias and detection bias) | Low risk | Unblinded assessment; assessor not involved in the provision of care |
| Incomplete outcome data (attrition bias) | Low risk | No losses to follow‐up |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Canada Patients recovering from a stroke Mean age (SD): T: 70.3 (12.7); C: 69.6 (12.7) N = 114 (Treatment: 58; C: 56) | |
| Interventions | Early discharge hospital outreach Type of service: multidisciplinary team: physiotherapist, occupational therapist, dedicated nurses, speech therapist Control group: inpatient hospital care Study dates: not reported (study conducted over 2 years) | |
| Outcomes | Main outcome: functional status Other outcomes: mortality; quality of life; length of stay Follow‐up: 1 month and 3 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stratified blocked balanced randomisation |
| Allocation concealment (selection bias) | Low risk | Done by central office independent of the research team |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality and length of stay |
| Blinding (performance bias and detection bias) | Low risk | Done by blinded assessor |
| Incomplete outcome data (attrition bias) | Low risk | Attrition < 10% and similar for both groups |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients with chronic obstructive pulmonary disease Mean age: Treatment: 69.7; C: 70.1 N = 60 (T: 30; C: 30) | |
| Interventions | Hospital at home (early discharge within 48 hours of admission) Type of service: daily monitoring by 2 respiratory outreach nurses who were accessible by phone daily from 9:00 to 17:00, out‐of‐hours advice from Medical Chest Unit: GPs aware but not involved in care Those living alone with no phone were excluded from the trial Control group: inpatient hospital care Study dates: May 1999 and February 2000 | |
| Outcomes | Length of stay; days of care; symptom score; respiratory function; patient and caregiver satisfaction Follow‐up: 2 weeks for satisfaction, 3 months for readmission | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not reported |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for respiratory function and symptom score; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for length of stay and days of care |
| Blinding (performance bias and detection bias) | Unclear risk | Method not reported |
| Incomplete outcome data (attrition bias) | Unclear risk | Attrition rate < 10%, similar proportion for both groups |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients recovering from a knee replacement Age: no data N= 60 (T: 32; C: 28) | |
| Interventions | Hospital at home (early discharge) Type of service: orthopaedic outreach team (2 orthopaedic nurses, a healthcare assistant, a physiotherapist) provide domiciliary care and a 24‐hour on‐call service Control group: inpatient hospital care Study dates: December 1997 to October 1998 | |
| Outcomes | Clinical condition of the knee joint; complications; readmission; patient satisfaction Follow‐up: 6 weeks, 12 weeks, and 1 year | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for knee and functional scores; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for readmission |
| Blinding (performance bias and detection bias) | Low risk | Completed by the patients and returned anonymised |
| Incomplete outcome data (attrition bias) | Unclear risk | 86% completed follow‐up |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Chile Adult inpatients with a mix of conditions requiring interventions usually provided in the hospital Mean age: T: 56 (range 19 ‐ 91); C: 68 (range 19 ‐ 97) N = 59 (Treatment: 29; C: 30) | |
| Interventions | Early discharge hospital‐based outreach Type of service: multidisciplinary team composed of 2 nurses, 2 physiotherapists, 1 geriatrician, 1 social worker, 2 paramedic technicians. Specific visiting scheduling not provided Control group: inpatient hospital care Study dates: not reported | |
| Outcomes | Main outcome: length of hospitalisation, measured at discharge (considering both treatment modalities as hospitalisation) Other outcomes: delirium; pressure ulcers; ADLs; readmission (28‐day, 3‐month, 6‐month); emergency room visits (28‐day, 3‐month, 6‐month); mortality (28‐day, 3‐month, 6‐month) | |
| Notes | Only 57% of the expected sample was recruited | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Tailor‐made software; patients randomised after completing the baseline assessment (information provided by author) |
| Allocation concealment (selection bias) | Unclear risk | Method not reported |
| Baseline outcome measurements (selection bias) | High risk | Baseline outcome measurements done prior to intervention for functional status and delirium; groups differed for both |
| Baseline characteristics (selection bias) | High risk | Baseline characteristics of treatment and control groups differed for relevant characteristics (age and gender) |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for length of stay |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported who performed the follow‐up assessments for patient‐reported outcomes or how it was done |
| Incomplete outcome data (attrition bias) | High risk | Recruitment stopped before achieving complete estimated sample (57%) |
| Selective reporting (reporting bias) | High risk | No data reported for main outcome (length of hospitalisation) |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Elderly patients recovering from elective surgery or emergency medical admissions (31% fractured neck of femur, 21% other fractures, 11% hip replacement, 10% cerebrovascular accidents, 10% knee replacements, 22% miscellaneous reasons for admission) Mean age: 78.3 (SD 6.9) N = 241 (T: 160, of which 50 had a medical diagnosis; C: 81, of which 25 had a medical diagnosis) | |
| Interventions | Hospital at home (early discharge) Type of service: early discharge from hospital; no night care Control group: inpatient hospital care, which included development of care pathways and discharge planning Study dates: July 1994 and October 1995 | |
| Outcomes | Main outcomes: resources and cost Follow‐up: 4 weeks and 3 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Block‐stratified randomisation |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes produced independently of the research and clinical staff |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for self‐reported overall health; difference between groups adjusted for in the analysis |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for resources and cost |
| Blinding (performance bias and detection bias) | Low risk | Unblinded assessment; assessor not involved in the provision of care |
| Incomplete outcome data (attrition bias) | Low risk | Attrition < 10% and similar for both groups; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients recovering from a stroke Median age (range): T: 73 (47 ‐ 93); C: 73 (44 ‐ 91) N = 92 (T: 46; C: 46) | |
| Interventions | Hospital at home (early discharge) Type of service: community‐based stroke team that provided an in‐reach service to 3 local acute hospitals, visiting patients prior to discharge. Multidisciplinary team of occupational therapist, physiotherapist, speech and language therapist, social worker. Nursing provided by the primary care team. GP had clinical responsibility, with support from a consultant working in stroke medicine. The stroke team used a key worker approach and patients held a copy of their record which they or their caregiver could add to. Review meetings involved patients and caregivers in their homes. Care available 24 hours a day if required Control group: inpatient hospital care Study dates: February 1995 and January 1996 | |
| Outcomes | Quality of life; functional status; psychological well‐being; caregiver well‐being; readmission rate; place of discharge Follow‐up: 7‐10 days post‐discharge and 3 months post‐stroke | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computerised randomisation service |
| Allocation concealment (selection bias) | Low risk | Centralised randomisation service |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for readmission and place of discharge |
| Blinding (performance bias and detection bias) | Low risk | Unblinded assessment; assessor not involved in the provision of care |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate < 5%, similar proportion for both groups |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: UK Patients following elective surgery (hernia and varicose veins) Mean age: 43 years N = 360 (T: 117; C: 121; Convalescent: 122) | |
| Interventions | Hospital at home Type of service: organised by the hospital, provided by the community; clinical responsibility held by the GP Skill mix of HAH team: 15 GPs; district nurses Control group: inpatient hospital care Study dates: not reported | |
| Outcomes | Clinical complications; patient satisfaction; readmission; caregiver satisfaction Follow‐up: 2 to 3 weeks | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Restricted randomisation |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes |
| Baseline outcome measurements (selection bias) | Low risk | Baseline measures of the main outcomes of clinical complications, readmission, and satisfaction with treatment received at follow‐up were not relevant. |
| Baseline characteristics (selection bias) | High risk | Baseline characteristics of treatment and control groups not reported |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for readmission |
| Blinding (performance bias and detection bias) | Unclear risk | Unclear risk for clinical complications and satisfaction, as method of assessment not reported |
| Incomplete outcome data (attrition bias) | Unclear risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | Not clear |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: London, UK Patients recovering from a stroke Mean age (SD): T: 70 (11); C: 72 (12) N = 331 (T: 167; C: 164) | |
| Interventions | Hospital at home (early discharge) Type of service: co‐ordinated by hospital‐based consultant, community‐based nursing and therapy; 24‐hour care not available Control group: hospital care and hospital‐organised rehabilitation Study dates: January 1993 to July 1995 | |
| Outcomes | Main outcome: functional status Other outcomes: mortality; readmission; psychological well‐being; patient satisfaction; caregiver satisfaction; caregiver burden Follow‐up, 2 months, 4 months, and 6 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Restricted randomisation in permuted blocks of 10 |
| Allocation concealment (selection bias) | Low risk | Blank sealed opaque envelopes |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality and readmission |
| Blinding (performance bias and detection bias) | Low risk | Completed by blinded assessor |
| Incomplete outcome data (attrition bias) | Unclear risk | Attrition < 5%, similar proportion between groups |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Northamptonshire, UK Patients recovering from elective surgery or with a medical condition Mean age: T: 71; C: 70 (knee replacement T: 68, C: 72; hip replacement T: 71, C: 70; hysterectomy T: 45, C: 44; older patients with a medical condition T: 77, C: 76; COPD T: 71, C: 73) N = 538: T: 263, of which 65 had a medical diagnosis (15 of 65 had COPD), 37 were recovering from a hip replacement, 47 from a knee replacement and 114 from a hysterectomy; C: 275, of which 63 had a medical diagnosis (17 had COPD), 49 were recovering from a hip replacement, 39 from a knee replacement and 124 from a hysterectomy | |
| Interventions | Hospital at home (early discharge and admission avoidance) Type of service: community‐based nursing and therapy, nursing aids, GP had clinical responsibility Control group: inpatient hospital care Study dates: October 1994 to November 1996 | |
| Outcomes | Mortality; readmission; functional status; psychological well‐being; quality of life; patient satisfaction; caregiver satisfaction; caregiver burden; resource use; cost Follow‐up: 1 month and 3 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random sequence |
| Allocation concealment (selection bias) | Low risk | Telephone randomisation |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status and general health status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, readmission and length of stay |
| Blinding (performance bias and detection bias) | Unclear risk | Patient‐reported measures of outcome; participants and researchers aware of allocation group |
| Incomplete outcome data (attrition bias) | Low risk | Attrition < 12%, similar for both groups; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in the protocol were published |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Edinburgh, Scotland Patients with COPD Mean age (range): T: 68.5 (39 ‐ 84); C: 69.9 (51 ‐ 86) N = 184 (T: 122; C: 62) | |
| Interventions | Hospital at home (early discharge from admissions unit) Type of service: acute respiratory assessment service nurse, medical advice from on‐call respiratory team and GP; out‐of‐hours care provided by GP Control group: inpatient hospital care Study dates: November 1996 to May 1998 | |
| Outcomes | Respiratory function; quality of life; additional care; GP satisfaction; costs Follow‐up: 8 weeks | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random numbers in a 2:1 ratio |
| Allocation concealment (selection bias) | Unclear risk | Method not reported |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for respiratory function and disease‐related characteristics; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for costs and additional care |
| Blinding (performance bias and detection bias) | Unclear risk | Data collected by the same nurse who provided care |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate < 6% |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Thailand Recovering from a stroke Mean age (SD): T: 58.4 years (9.6); C: 59.8 (9.9) N = 102 (T: 52; C: 50) | |
| Interventions | Type of service: community‐based early discharge service, run by Red Cross volunteers; family members were trained to give injections under nurse guidance while the patient was in hospital, and encouraged to participate in physical and occupational therapy so they could help with home rehabilitation Control group: inpatient hospital care Study dates: December 1998 to August 1999 | |
| Outcomes | Mortality; functional status; satisfaction Follow‐up: 6 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not described |
| Allocation concealment (selection bias) | Unclear risk | Method not described |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for stroke‐related characteristics; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality |
| Blinding (performance bias and detection bias) | Unclear risk | Method not described |
| Incomplete outcome data (attrition bias) | Low risk | No losses to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | Not clear from authors' description |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Italy Adult inpatients with 2+ episodes of hospitalisation for decompensating heart failure in the last 6 ‐ 12 months Mean age: 81 N = 52 (T: 26; C: 26) | |
| Interventions | Early discharge hospital‐based outreach Type of service: multidisciplinary team composed of nurses, physiotherapists,geriatricians, and social worker, available from 8 a.m. to unstated closure time. Specific visit scheduling not provided. 24‐hour care mostly provided by out‐of‐hours service but 24‐hour advice also available from the team Control group: inpatient hospital care Study dates: September 2008 to May 2010 | |
| Outcomes | Mortality, place of discharge, number of readmissions and causes of readmission, length of stay, functional and cognitive status, psychological well‐being, nutritional status and quality of life, pain perception and their state of health, caregiver stress Follow‐up: 1 month | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method not reported |
| Allocation concealment (selection bias) | Low risk | Allocation occurred 12 ‐ 24 hours after hospital admission, and after initial stabilisation treatment and baseline measurements, and consenting |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional and cognitive status, psychological well‐being, quality of life, pain; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality, place of discharge, readmission and length of stay |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported who performed the follow‐up assessments for patient‐reported outcomes |
| Incomplete outcome data (attrition bias) | Low risk | All patients accounted for |
| Selective reporting (reporting bias) | High risk | Authors state several measures collected at follow‐up for which results are not reported |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: The Netherlands Patients aged ≥ 40 years with COPD exacerbations Mean age (SD): T: 68.3 (10.3), C: 67.8 (11.3) N = 139 (T: 70; C: 69) | |
| Interventions | Early discharge hospital‐based outreach Type of service: all patients treated in hospital for 3 days, T discharged home on day 4, followed by home visits by nurses on 4 consecutive days; respiratory physician supervised nurses' performance and had clinical responsibility. 24‐hour support provided by the hospital (phone number provided). GPs were informed about patients' participation but not directly involved Control group: inpatient hospital care (7 days) Study dates: November 2007 to March 2011 | |
| Outcomes | Main outcome: changes in Clinical COPD Questionnaire scores Other outcomes: number of treatment failures; number of readmissions and time to readmission; mortality and time to death; health‐related quality of life; caregiver burden; patient and primary informal caregiver satisfaction Follow‐up: 3 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation performed using a computer‐generated randomisation list with sealed envelopes |
| Allocation concealment (selection bias) | Low risk | Independently done |
| Baseline outcome measurements (selection bias) | Unclear risk | Baseline outcome measurements done prior to intervention for clinical characteristics; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for mortality and readmission |
| Blinding (performance bias and detection bias) | Unclear risk | Collected by unblinded trial nurses |
| Incomplete outcome data (attrition bias) | Low risk | > 80% participants retained; intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | All protocol outcomes reported |
| Study characteristics | ||
| Methods | Randomised trial | |
| Participants | Location: Stockholm, Sweden Patients recovering from a stroke Mean age (SD): T: 70.8 years (7.6); C: 72.6 (8.9) N = 81 (T: 41; C: 40) | |
| Interventions | Hospital at home Type of service: community‐based nursing and therapy Study dates: September 1993 to March 1996 | |
| Outcomes | Functional status; psychological well‐being; patient satisfaction; use of hospital and home rehabilitation service Follow‐up: 3 months | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computerised random block procedure |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes; done independently |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status; similar results between groups |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of treatment and control groups are reported and similar |
| Blinding (performance bias and detection bias) | Low risk | Objective outcomes for use of health services |
| Blinding (performance bias and detection bias) | Low risk | Done by blinded assessor |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate < 3% |
| Selective reporting (reporting bias) | Low risk | All outcomes reported in Methods also reported in Results |
ADLs: activities of daily living; C: control group; COPD: chronic obstructive pulmonary disease; GP: general practitioner; HAH: hospital at home; ICU: intensive care unit; IQR: interquartile range; SD: standard deviation; T: treatment group
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Secondary analysis of a trial that compared 2 interventions for acute ischaemic stroke; no hospital at home was provided as part of the intervention | |
| This study evaluated early discharge from hospital of women following surgery for breast cancer; no hospital at home was provided | |
| Protocol for a randomised trial; usual care will not be provided in hospital | |
| Obstetrics (this group of patients was not included in the review) | |
| Intervention focussed on hospital inpatient rehabilitation followed by a home programme | |
| This study evaluated early discharge from hospital of women following surgery for breast cancer; no hospital at home was provided | |
| Small feasibility study (N = 14) | |
| Intervention group received care both at home and as an outpatient | |
| Participants allocated to early discharge followed up in outpatient clinics, not at home | |
| Intervention could be provided either at home or in an outpatient clinic | |
| No standard measures of outcome used. A physician, not blind to the patients' group assignment, assessed clinical function. No criteria were used to define an untoward event. No intention‐to‐treat analysis, data were analysed by the care the patient received | |
| The comparison group was also discharged home | |
| This study did not evaluate hospital at home, but a model for follow‐up visits at home after discharge from hospital | |
| 39% of those allocated to hospital care were not admitted to hospital, so the degree to which the intervention substituted for hospital care is not clear | |
| This study evaluated hospital at home care for patients with a myocardial infarction. Managing this group of patients totally at home is now obsolete, as thrombolytic therapy has made admission to hospital necessary | |
| Randomised trial that compared 2 early supported discharge models, 1 provided health care in a day unit and the other in the patients’ homes. A third group were allocated to an institutional stay if necessary and/or physiotherapy as needed in the municipality (0 – 2 hours per week) | |
| This study compared patients treated with intravenous standard heparin administered in hospital with fixed dose subcutaneous low‐molecular weight heparin administered at home, when feasible. Patients were taught to self‐administer the low molecular weight heparin. Care was not provided in the patients' homes by a team of healthcare professionals; the intervention was not therefore considered hospital at home | |
| This study compared the use of intravenous standard heparin administered in the hospital with the administration of subcutaneous low molecular weight heparin primarily at home. The study nurse taught the patient to administer the medication. Care was not provided in the patients' homes by a team of healthcare professionals; the intervention was not therefore considered hospital at home | |
| This trial recruited 22 patients to compare the acceptance of inpatient with home continuous intravenous infusion of chemotherapy. While in hospital patients were instructed on the use of the infusers before discharge. The infusion was delivered in a continuous flow over 24 hours and new defusers were attached by the patient. Care was not provided in the patients' homes by a team of healthcare professionals. The intervention was not therefore considered hospital at home as no additional services were provided | |
| Participants allocated to early discharge followed up in outpatient clinics, not at home | |
| This study evaluated hospital at home care for patients with a myocardial infarction. Managing this group of patients totally at home is now obsolete, as thrombolytic therapy has made admission to hospital necessary | |
| Recruited patients with long‐term care needs. Hospital at home was a substitute for long‐term care | |
| Recruited patients with long‐term care needs. Hospital at home was a substitute for long term care | |
| Early discharge programme, hospital at home services not provided | |
| The intervention was a supported discharge service. Healthcare was provided by healthcare assistants, registered nurses and allied health professionals. Consultant geriatricians provided weekly input through case conferences. Healthcare was provided for up to 4 visits a day, 7 days a week. The control group received discharge planning and community based services as required. | |
| Intervention was not early discharge but instead a combination of pre‐discharge home intervention, hospital intervention, and post‐discharge intervention | |
| Compares therapies at home, no comparison with hospital care | |
| Inpatient hospital rehabilitation compared with rehabilitation provided by the municipalities in a variety of settings which included nursing home rehabilitation on an inpatient or outpatient basis, and further ambulatory rehabilitation by a visiting physical therapist, speech therapist and/or nurse. Primary care also provided | |
| Intervention was home supported discharge, authors confirmed the intervention was not hospital at home. | |
| Some of the participants allocated to control group were discharged to a convalescent home mid‐trial | |
| A case‐control study, with control patients selected to match the homecare patients | |
| Compared 2 districts, with and without a domiciliary stroke service | |
| Qualitative study reporting on a small trial (N = 9) | |
| Patients were randomly allocated to 24‐hour bed rest in hospital or mobilisation at home following intra‐articular irradiation of the knee with yttrium‐90. No additional services were provided at home | |
| Intravenous therapy, analysis based on number of readmissions, data not provided on number of people readmitted. Authors contacted, no reply | |
| Evaluated the effectiveness of a home care programme for home‐bound chronically ill patients. The home care programme was not a substitute for inpatient hospital care, but an addition to existing community services. | |
| Evaluated the effectiveness of a home care programme for home bound chronically ill patients. The home care programme was not a substitute for in‐patient hospital care, but an addition to existing community services. |
Characteristics of ongoing studies [ordered by study ID]
| Study name | |
| Methods | |
| Participants | |
| Interventions | |
| Outcomes | |
| Starting date | |
| Contact information | |
| Notes |
| Study name | |
| Methods | |
| Participants | |
| Interventions | |
| Outcomes | |
| Starting date | |
| Contact information | |
| Notes |
| Study name | GOThenburg Very Early Supported Discharged (GOTVED) |
| Methods | Single‐blind randomised trial with parallel assignment |
| Participants | Adults aged 18+ years with confirmed moderate to severe stroke and life expectancy of > 1 year |
| Interventions | Home visits performed by a rehabilitation team (physiotherapists, occupational therapists and a stroke nurse). Person‐centred approach |
| Outcomes | Main outcomes: anxiety and depression at 1‐, 3‐, and 12‐month follow‐up Other outcomes: functional status, balance, quality of life, impact of stroke and readmission; all at 1‐, 3‐, and 12‐month follow‐up |
| Starting date | May 2011 (estimated completion date July 2016) |
| Contact information | |
| Notes | ClinicalTrials.gov NCT01622205 2020 update: completed (Phase 1), some data available ‐ add to included studies |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size | |||||||||||||||||||||||||||||||||||||||
| 1.1 Mortality at 3 ‐ 6 months Show forest plot | 11 | 1114 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.57, 1.48] | |||||||||||||||||||||||||||||||||||||||
| Analysis 1.1  Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 1: Mortality at 3 ‐ 6 months | |||||||||||||||||||||||||||||||||||||||||||
| 1.2 Mortality at 12 months Show forest plot | 4 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.2
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 2: Mortality at 12 months | |||||||||||||||||||||||||||||||||||||||||||
| 1.3 Hospital readmission at 3 ‐ 6 months Show forest plot | 5 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.71, 1.66] | |||||||||||||||||||||||||||||||||||||||
| Analysis 1.3  Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 3: Hospital readmission at 3 ‐ 6 months | |||||||||||||||||||||||||||||||||||||||||||
| 1.4 Hospital readmission at 12 months follow‐up Show forest plot | 2 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.4
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 4: Hospital readmission at 12 months follow‐up | |||||||||||||||||||||||||||||||||||||||||||
| 1.5 Functional status Show forest plot | 10 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.5
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 5: Functional status | |||||||||||||||||||||||||||||||||||||||||||
| 1.6 Patient outcomes Show forest plot | 8 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.6
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 6: Patient outcomes | |||||||||||||||||||||||||||||||||||||||||||
| 1.6.1 Quality of life/self‐reported health status | 7 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| 1.6.2 Psychological well‐being | 2 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| 1.7 Institutional care at 6 months follow‐up (Rodgers 3‐month data) Show forest plot | 4 | 574 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.40, 0.98] | |||||||||||||||||||||||||||||||||||||||
| Analysis 1.7  Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 7: Institutional care at 6 months follow‐up (Rodgers 3‐month data) | |||||||||||||||||||||||||||||||||||||||||||
| 1.8 Patient satisfaction and preference for place of care Show forest plot | 6 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.8
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 8: Patient satisfaction and preference for place of care | |||||||||||||||||||||||||||||||||||||||||||
| 1.9 Caregiver outcomes Show forest plot | 5 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.9
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 9: Caregiver outcomes | |||||||||||||||||||||||||||||||||||||||||||
| 1.10 Hospital length of stay Show forest plot | 4 | 528 | Mean Difference (IV, Fixed, 95% CI) | ‐6.68 [‐10.19, ‐3.17] | |||||||||||||||||||||||||||||||||||||||
| Analysis 1.10  Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 10: Hospital length of stay | |||||||||||||||||||||||||||||||||||||||||||
| 1.11 Length of stay: inpatient days (including readmission days) and home‐based treatment Show forest plot | 9 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.11
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 11: Length of stay: inpatient days (including readmission days) and home‐based treatment | |||||||||||||||||||||||||||||||||||||||||||
| 1.12 Cost and use of other services Show forest plot | 5 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Analysis 1.12
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 12: Cost and use of other services | |||||||||||||||||||||||||||||||||||||||||||
| 1.12.1 Cost | 4 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| 1.12.2 Use of other services | 3 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.1 Mortality at 3 ‐ 6 months ‐ older people with a mix of conditions Show forest plot | 8 | 1247 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.76, 1.49] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.1  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 1: Mortality at 3 ‐ 6 months ‐ older people with a mix of conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.2 Mortality ‐ chronic obstructive pulmonary disease Show forest plot | 5 | 496 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.25, 1.12] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.2  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 2: Mortality ‐ chronic obstructive pulmonary disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.3 Hospital readmission at 3 months ‐ older people with a mix of conditions Show forest plot | 9 | 1276 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.25 [0.98, 1.58] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.3  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 3: Hospital readmission at 3 months ‐ older people with a mix of conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.4 Hospital readmission for those with COPD Show forest plot | 5 | 496 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.66, 1.13] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.4  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 4: Hospital readmission for those with COPD | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.5 Functional status ‐ older people a mix of conditions, including COPD Show forest plot | 8 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.5
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 5: Functional status ‐ older people a mix of conditions, including COPD | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.5.1 Functional status | 8 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.5.2 Falls | 1 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.6 Functional status at 3 months ‐ older people with a mix of conditions Show forest plot | 4 | 639 | Mean Difference (IV, Fixed, 95% CI) | 0.34 [‐0.18, 0.86] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.6  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 6: Functional status at 3 months ‐ older people with a mix of conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.7 Patient‐reported outcomes Show forest plot | 12 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.7
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 7: Patient‐reported outcomes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.7.1 Quality of life/self‐reported health status: Older people with a mix of conditions | 5 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.7.2 Quality of life/self‐reported health status: Older people with COPD | 4 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.7.3 Cognitive functioning | 5 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.7.4 Psychological well‐being | 7 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.8 Institutional care at 1 year follow‐up (Donald 6 months) ‐ older patients with a mix of conditions Show forest plot | 3 | 484 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.48, 0.99] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.8  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 8: Institutional care at 1 year follow‐up (Donald 6 months) ‐ older patients with a mix of conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.9 Patients' place of residence at follow‐up (not included in meta‐analysis) Show forest plot | 2 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.9
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 9: Patients' place of residence at follow‐up (not included in meta‐analysis) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.10 Patient satisfaction and preference for place of care Show forest plot | 6 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.10
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 10: Patient satisfaction and preference for place of care | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.11 Caregiver outcomes Show forest plot | 7 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.11
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 11: Caregiver outcomes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.12 Staff views Show forest plot | 2 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.12
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 12: Staff views | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.13 Length of stay Show forest plot | 11 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.13
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 13: Length of stay | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.13.1 Inpatient days (including readmission days) and hospital at home length of stay (not included in meta‐analysis) | 8 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.13.2 Total length of stay ‐ hospital plus hospital at home | 3 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.14 Hospital length of stay ‐ older people with a mix of conditions Show forest plot | 4 | 613 | Mean Difference (IV, Fixed, 95% CI) | ‐6.76 [‐10.60, ‐2.92] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.14  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 14: Hospital length of stay ‐ older people with a mix of conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.15 Total length of stay ‐ older people with a mix of mainly medical conditions Show forest plot | 3 | 378 | Mean Difference (IV, Fixed, 95% CI) | 6.43 [2.84, 10.03] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.15  Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 15: Total length of stay ‐ older people with a mix of mainly medical conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.16 Cost and resource use Show forest plot | 9 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Analysis 2.16
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 16: Cost and resource use | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.16.1 Cost | 7 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 2.16.2 Use of other services | 3 | Other data | No numeric data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size | |||||||||||||||||||||
| 3.1 Mortality Show forest plot | 3 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.1
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 1: Mortality | |||||||||||||||||||||||||
| 3.2 Hospital readmission Show forest plot | 5 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.2
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 2: Hospital readmission | |||||||||||||||||||||||||
| 3.3 Functional status Show forest plot | 2 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.3
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 3: Functional status | |||||||||||||||||||||||||
| 3.4 Patient outcomes: Quality of life/self‐reported health status Show forest plot | 5 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.4
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 4: Patient outcomes: Quality of life/self‐reported health status | |||||||||||||||||||||||||
| 3.5 Clinical complications Show forest plot | 3 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.5
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 5: Clinical complications | |||||||||||||||||||||||||
| 3.6 Patient satisfaction Show forest plot | 5 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.6
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 6: Patient satisfaction | |||||||||||||||||||||||||
| 3.7 Caregiver outcomes Show forest plot | 4 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.7
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 7: Caregiver outcomes | |||||||||||||||||||||||||
| 3.8 Staff views ‐ GP workload Show forest plot | 4 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.8
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 8: Staff views ‐ GP workload | |||||||||||||||||||||||||
| 3.9 Hospital length of stay ‐ older people recovering from surgery Show forest plot | 4 | 411 | Mean Difference (IV, Fixed, 95% CI) | ‐4.44 [‐6.37, ‐2.51] | |||||||||||||||||||||
| Analysis 3.9  Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 9: Hospital length of stay ‐ older people recovering from surgery | |||||||||||||||||||||||||
| 3.10 Length of stay (not included in meta‐analysis) Show forest plot | 3 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.10
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 10: Length of stay (not included in meta‐analysis) | |||||||||||||||||||||||||
| 3.11 Total length of stay ‐ older people having elective surgery Show forest plot | 2 | 245 | Mean Difference (IV, Fixed, 95% CI) | 2.79 [0.77, 4.81] | |||||||||||||||||||||
| Analysis 3.11  Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 11: Total length of stay ‐ older people having elective surgery | |||||||||||||||||||||||||
| 3.12 Cost Show forest plot | 5 | Other data | No numeric data | ||||||||||||||||||||||
| Analysis 3.12
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 12: Cost | |||||||||||||||||||||||||
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 1: Mortality at 3 ‐ 6 months
| Mortality at 12 months | ||
| Study | Results | Notes |
|---|---|---|
| Askim 2004 | T: 8/31 (25.8%); C: 5/31 (16.1%) Difference 9.7%, 95% CI ‐10.8 to 29.3 | 12 months follow‐up |
| Cunliffe 2004 | T: 6/43 (13.9%); C: 1/44 (2.3%) Difference 11.7%, 95% CI ‐0.4 to 25.1 | 12 months follow‐up |
| Donnelly 2004 | T: 2/59 (3.4%); C: 3/54 (5.6%) Difference ‐2.2%, 95% CI ‐12.0 to 6.8 | 12 months follow‐up |
| Rudd 1997 | T: 26/167 (15.6%); C: 34/164 (20.7%) Difference ‐5.1%, 95% CI ‐13.5 to 3.2 | 12 months follow‐up |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 2: Mortality at 12 months
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 3: Hospital readmission at 3 ‐ 6 months
| Hospital readmission at 12 months follow‐up | |
| Study | Results |
|---|---|
| Donnelly 2004 | 12 months |
| Rudd 1997 | 12 months |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 4: Hospital readmission at 12 months follow‐up
| Functional status | ||
| Study | Results | Notes |
|---|---|---|
| Anderson 2000 | Barthel Index 6 months ‐ Median (IQR) | Modified Barthel Index 10 items covering activities of daily living (e.g. feeding, toilet use) Scores 5 to 50 (higher scores: more independent) |
| Askim 2004 | Modified Rankin Scale * At 6 weeks | * Modified Rankin Scale 7 items covering stroke‐related disability Scores 0 to 6 (higher scores = more disability) Score of < 2 classified as independent ** Barthel Index Max score 100; Independent > 95 |
| Bautz‐Holter 2002 | Nottingham extended ADL 6 months ‐ Median (IQR) | Nottingham extended ADL 22 items covering stroke‐related ADLs (four domains plus total score) Higher scores: more independence |
| Donnelly 2004 | Barthel ADL 10‐minute timed walk 12 months ‐ Mean (SD) | 12‐month follow‐up |
| Indredavik 2000 | Barthel Index (independent) * 26 weeks | * Barthel Index Authors reported %, numbers derived from percentages ** Rankin Scale, odds ratio for independence: Rankin scale < 2 vs Rankin scale 3 to 6 ^ Excluding those with a very mild stroke Barthel Index > 95 ^^ Excluding those with a mild stroke Rankin score < 2 |
| Mayo 2000 | Barthel Index * 1 month ‐ Mean (SD) T: 94.3 (10.6); C: 93.3 (10.1) Difference 1 (95% CI ‐3.13 to 5.13) 3 month ‐ Mean (SD) T: 97. (6.9), C: 95.1 (10.6) Difference 2 (95% CI ‐1.69 to 5.69) OARS‐IADL ** 1 month ‐ Mean (SD) T: 10.1 (3.5); C: 8.6 (3.5) Difference 1.5 (95% CI 0.13 to 2.87) 3 month ‐ Mean (SD) T: 11.0 (3.5); C: 9.5 (3.9) Difference 1.5 (95% CI ‐0.01 to 3.01) STREAM ^ 1 month ‐ Mean (SD) T: 90.3 (12.4); C: 91.7 (10.1) Difference ‐1.4 (95% CI ‐5.89 to 3.09) 3 month ‐ Mean (SD) T: 93.3 (11.7); C: 92.9 (10.0) Difference 0.4 (95% CI ‐4.11 to 4.91) | * Barthel Index ** Older Americans Resource Scale for Instrumental ADL 7‐item scale ranging 0 to 14 (higher score: greater impairment) ^ Stroke Rehabilitation Assessment of Movement 30‐item scale ranging 0 to 100 (higher score: more voluntary movement) |
| Rodgers 1997 | Oxford Handicap Scale * Categories 0 ‐ 2 T: 28/45 (62%); C 22/42 (52%) Difference 9.8% (95% CI ‐10.9% to 30.5%) T: 8/45 (18%); C 10/42 (24%) Difference 6% (95% CI ‐23% to 11%) Categories 4‐5 T: 9/45 (20%); C: 10 /42 (24%) Difference 4% (95% CI ‐21% to 14%) Median (range) T: 3 (0 ‐ 6); C: 1 (0 ‐ 6) T: 4 (0 ‐ 5); C: 3 (0 ‐ 5) T:1 (0 ‐ 4); C: 0 (0 ‐ 5) T: 2 (0 ‐ 4); C: 2 (0 ‐ 6) T: 10 (0 ‐ 18); C: 7 (0 ‐ 21) | * Oxford Handicap Scale (Categories 0 ‐ 5) No symptoms, minor symptoms, minor handicap, moderate handicap, moderately severe handicap, and severe handicap ** Nottingham Extended ADL Scores at 3 month follow‐up |
| Rudd 1997 | Barthel Index * 12 month ‐ Mean (SD) 12 month ‐ Mean (SD) 12 month ‐ Mean (SD in seconds) | * Barthel Index (0 ‐ 20) ** Frenchay Aphasia Screening Test Scores < 13 indicates aphasia ^ Rivermead activities of daily living scale Scores range 15 ‐ 45 (lower scores: higher dependence) ^^ 5‐metre timed walk |
| Suwenwela 2001 | NIH stroke scale * | * NIH Stroke Scale 11‐item scale for stroke‐related symptoms (0 ‐ 42) Higher scores: more symptoms Proportion of patients who scored 0 ‐ 2 at 6‐month follow‐up Proportion of patients who scored 75 ‐ 100 at 6‐month follow‐up |
| Widén Holmqvist 1998 | Functional status 1 * Functional status 2 ** Difference 9% (95% CI ‐12% to 30%), P = 0.53 Functional status 3 ^ Difference 5.8% (95% CI ‐15% to 26%), P = 0.75 Functional status 4 ^^ | * Functional status 1: independent in personal ADL ** Functional status 2: independent in instrumental ADL ^ Functional status 3: independent in Barthel ^^ Functional status 4: Median time (IQR) taken to walk 10 metres Median score and (IQR) All results for 3‐month follow‐up At baseline T had 10% lower coping capacity, increased frequency of disease (TIA and diabetes), increased frequency of abnormal CT scans on admission and left hemisphere lesions. |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 5: Functional status
| Patient outcomes | ||
| Study | Results | Notes |
|---|---|---|
| Quality of life/self‐reported health status | ||
| Anderson 2000 | SF‐36 * 6 months ‐ Mean (SD) Physical functioning NHP ** 6 months ‐ Median (IQR) Energy | * Short form survey of self‐reported health status 36 items, higher scores indicate better self‐perceived health status ** Nottingham Health Profile Part 1 has 38 items focusing on 6 health domains Higher scores: lower self‐perceived health |
| Askim 2004 | NHP * Global score Mean (SD) 26 weeks ‐ Median (IQR) Global score 52 weeks ‐ Median (IQR) Median (IQR) | * Nottingham Health Profile Part 1 has 38 items focusing on 6 health domains Maximum score 100 within each domain Higher scores: lower self‐perceived health |
| Donnelly 2004 | EuroQol * 12 months ‐ Mean (SD) Physical functioning Mental health | * EQ‐5D Self‐reported health status 5 levels (1: no problems; 5: extreme problems) ** Short form survey of self‐reported health status 36 items, higher scores indicate better self‐perceived health status |
| Mayo 2000 | SF 36 Physical function | SF 36 scored out of 100 1 month follow‐up T: N = 56; C: N = 47 3‐month follow‐up T: N = 47; C: N = 44 |
| Rodgers 1997 | Dartmouth COOP charts 3 month ‐ Median (range) Physical fitness Social support T: 2 (1 ‐ 5); C: 3 (1 ‐ 5) | Dartmouth COOP charts 7 items covering different domains of health status Each domain scored 1 ‐ 5 (low score: better quality of life) Mean change at 3 months from baseline T: N = 45; C: N = 42 No differences between groups (as reported by the authors) |
| Rudd 1997 | NHP 12 month ‐ Mean (SD) | Nottingham Health Profile |
| Widén Holmqvist 1998 | SIP ‐ Median (IQR) Overall T: 17.6 (0.0 to 31.3); C: 0.0 (0.0 to 19.7) P = 0.02 | Overall SIP ‐ Sickness Impact Profile |
| Psychological well‐being | ||
| Bautz‐Holter 2002 | MADRS * | * Montgomery Asberg Depression Rating Scale 10‐item, score 0 ‐ 60 Higher scores: more depressive symptoms ** General Health Questionnaire Higher scores = worse mental health |
| Rudd 1997 | HADS 95% CI ‐4.3% to 8.8% Abnormal 95% CI ‐0.4% to 12.3% Aggregated data for borderline and abnormal (assessed and not assessed) | Hospital Anxiety Depression Scale 14‐item scale, ranging from 0 ‐ 23 (for each subscale of anxiety and depression) Higher scores: worse mental health |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 6: Patient outcomes
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 7: Institutional care at 6 months follow‐up (Rodgers 3‐month data)
| Patient satisfaction and preference for place of care | ||
| Study | Results | Notes |
|---|---|---|
| Anderson 2000 | Satisfied with recovery | Questionnaire developed for the study (not described) Results at 6‐month follow‐up |
| Bautz‐Holter 2002 | Patient satisfaction T: 18/24, C: 10/21, P = 0.06 | 4‐point Likert scale of agreement with satisfaction with rehabilitation |
| Donnelly 2004 | Patient satisfaction Overall satisfaction 12 months ‐ Mean (SD) | Patient satisfaction questionnaire developed by Pound 1994 12 items, higher scores: more satisfaction Results at 12‐month follow‐up |
| Rudd 1997 | Satisfaction with hospital care | Stroke‐specific questionnaire (not described) |
| Suwenwela 2001 | Satisfaction with treatment Difference 49% (95% CI 30% to 63%) | Questionnaire not described |
| Widén Holmqvist 1998 | Patient satisfaction with active participation in treatment: | No other data reported. Results on other dimensions of patient satisfaction not reported Questionnaire not described |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 8: Patient satisfaction and preference for place of care
| Caregiver outcomes | ||
| Study | Results | Notes |
|---|---|---|
| Askim 2004 | Caregiver strain 6 weeks ‐ Mean (SD) Difference 1.0 (95% CI ‐0.2 to 2.2) Difference 0.8 (95% CI ‐2.0 to 0.4) 52 weeks ‐ Mean (SD) Difference ‐0.5 (95% CI ‐1.9 to 0.9) | Carer Strain Index 13‐item scale, range 0 ‐ 13 Higher score: more strain N at 6 weeks: T: 29; C: 29 N at 26 weeks: T: 22; C: 23 N at 52 weeks: T: 23; C: 22 |
| Bautz‐Holter 2002 | Caregiver satisfaction T: 12/19; C: 3/10, P = 0.09 | 4‐point Likert scale of agreement with satisfaction with rehabilitation |
| Donnelly 2004 | Caregiver strain | Carer Strain Index N: T: 27; C: 25 |
| Rodgers 1997 | GHQ | N: T: 22; C: 19 No differences between groups (as reported by authors) |
| Rudd 1997 | Caregiver Strain * Mean (SD) Median (range) | * Carer Strain Index 13‐item scale, range 0 ‐ 13 Higher score: more strain ** Carer satisfaction with hospital care ‐ denominator is not clear |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 9: Caregiver outcomes
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 10: Hospital length of stay
| Length of stay: inpatient days (including readmission days) and home‐based treatment | ||
| Study | Results | Notes |
|---|---|---|
| Anderson 2000 | Total hospital bed days ‐ Median (IQR) Length of home‐based rehabilitation ‐ Median (range) | |
| Askim 2004 | Stroke Unit total days ‐ Mean (SD) Difference ‐0.7 (95% CI ‐7.1 to 5.7) Difference ‐7.0 (95% CI ‐26.1 to 12.1) | T: N = 31, C: N = 31 |
| Bautz‐Holter 2002 | Hospital stay ‐ Median days | No SD provided; P value provided by authors |
| Donnelly 2004 | Hospital stay ‐ Mean days T: 42; C: 50 Hospital stay ‐ Median days T: 31; C: 32 | No SD provided for hospital stay |
| Indredavik 2000 | Stroke unit days ‐ Mean | No SD provided P value for days in unit and rehabilitation provided by authors |
| Mayo 2000 | Hospital length of stay days ‐ Mean (SD) Difference ‐2.6 (95% CI ‐5.0 to ‐0.2) T: 9.8 (5.3); C: 16.1 (14.6) Difference ‐6.3 (95% CI ‐10.4 to ‐2.2) | T: N = 58, C: N = 56 |
| Rodgers 1997 | Hospital length of stay ‐ Median (IQR) Hospital at home length of stay ‐ Median (range) 9 weeks (1 to 44 weeks) | |
| Rudd 1997 | Length of stay to randomisation ‐ Mean (SD) Mean (SD) Median (range) | No data for hospital at home length of stay T: N = 167; C: N = 164 |
| Widén Holmqvist 1998 | Hospital length of stay ‐ Mean (range) | |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 11: Length of stay: inpatient days (including readmission days) and home‐based treatment
| Cost and use of other services | ||
| Study | Results | Notes |
|---|---|---|
| Cost | ||
| Anderson 2000 | Hospital costs 6 months post‐randomisation ‐ Mean (SD)/patient T: AUD 3142 (AUD 2743); C: AUD 7820 (AUD 6018) Home‐based rehabilitation 6 months post‐randomisation ‐ Mean (SD)/patient T: AUD 2985 (AUD 1659); C: AUD 79 (0) Community services 6 months post‐randomisation ‐ Mean (SD)/patient T: AUD 778 (AUD 1415); C: AUD 1460 (AUD 2502) T: AUD 1135 (AUD 402); C: AUD 695 (AUD 1020) Total 6 months post‐randomisation ‐ Mean (SD)/patient T: AUD 8040 (AUD 4439); C: AUD 10,054 (AUD 7676) Sensitivity analysis: impact on health care costs Initial hospital costs 75% of baseline | Costs calculated for each patient's use of healthcare resources in the 6 months from randomisation, with an average per patient cost used if detailed information on patients was not available. Costs in Australian dollars (AUD) 1997/1998 |
| Donnelly 2004 | 6 months ‐ Mean cost per patient (SD) | Health service perspective, financial accounts were used to cost hospital care; costs collected from patients using a service use questionnaire and unit costs of health and social care to cost hospital at home care |
| Mayo 2000 | Resources months ‐ Mean cost per patient (SD) Post‐randomisation acute care bed days ER visits | Healthcare perspective at the patient level Unit costs included overhead costs and an allowance for the opportunity cost of buildings and land Cost for 3 months follow‐up included Costs in Canadian dollars (CAD) |
| Rudd 1997 | Average annual cost Difference GBP ‐632.00 | Cost data in GBP (UK £), financial year 1997 Costs calculated at the level of the patient by using data from provider departments and other published sources No SD or P value provided, not possible to calculate CI |
| Use of other services | ||
| Anderson 2000 | Use of community services | |
| Bautz‐Holter 2002 | Provision of district nursing Provision of home care Provision of occupational therapy Provision of physiotherapy | N at 3 months: T: 34, C: 32 N at 6 months: T: 34, C: 31 |
| Mayo 2000 | Physiotherapist | Mean number of visits from each healthcare professional Although more visits on average in the control group, the proportion of patients receiving care in this group was less, 7 patients receiving extended rehabilitation account for the increased visits All patients in the intervention group received nursing visits, compared with 52% in the control group; 75% in the intervention group received physiotherapy, compared with 50% in the control group |
Comparison 1: Early discharge hospital at home versus inpatient care for those recovering from a stroke, Outcome 12: Cost and use of other services
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 1: Mortality at 3 ‐ 6 months ‐ older people with a mix of conditions
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 2: Mortality ‐ chronic obstructive pulmonary disease
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 3: Hospital readmission at 3 months ‐ older people with a mix of conditions
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 4: Hospital readmission for those with COPD
| Functional status ‐ older people a mix of conditions, including COPD | ||
| Study | Results | Notes |
|---|---|---|
| Functional status | ||
| Caplan 2006 | Functional status At enrolment ‐ Mean (SD) | Functional independence measure (FIM) Start of rehabilitation phase post‐randomisation Authors interpret as indication that intervention group required additional days in the acute ward, in order to be more independent before going home |
| Cunliffe 2004 | ADL * At 3 months Nottingham Extended ADL sections ^ At 3 months Kitchen Domestic Leisure | * Barthel Index Score: 0 to 20; 0 = worse score ** Score: 0 to 66; 0 = worse score ^ Score: 0 to 18; 0 = worse score |
| Donald 1995 | Functional status | Barthel Index (higher score: more independence) |
| Harris 2005 | Functional status * 10 day ‐ Mean (SD) 10 day ‐ Mean (SD) 10 day ‐ Mean (SD) | * Functional independence measure (FIM) ** Functional independence measure ‐ Physical ^ Instrumental activities of daily living All values calculated as changes from baseline |
| Martin 1994 | Functional status | * Barthel Index (0 ‐ 20) ^ Rivermead Score (9 ‐ 27) (higher score indicating better outcome) Measure of domestic abilities No P values given, insufficient data to calculate CI |
| Richards 1998 | 4 weeks ‐ Mean (SD) Difference 0.5 (95% CI ‐0.31 to 1.31) Difference 0.2 (95% CI ‐0.66 to 1.06) | Barthel Index N at 4 weeks: T: 152, C: 69 N at 3 months: T: 141, C: 60 |
| Shepperd 1998 | 3 months ‐ Mean change from baseline | Elderly medical patients Barthel Index, scale 0 to 20 (low score: high dependence) |
| Tibaldi 2013 | Similar scores for both groups at 1‐month follow‐up | Barthel Index No other data reported |
| Falls | ||
| Harris 2005 | Days 0 ‐ 10 | |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 5: Functional status ‐ older people a mix of conditions, including COPD
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 6: Functional status at 3 months ‐ older people with a mix of conditions
| Patient‐reported outcomes | ||
| Study | Results | Notes |
|---|---|---|
| Quality of life/self‐reported health status: Older people with a mix of conditions | ||
| Cunliffe 2004 | EQ‐5D (‐0.59 to 1) | Self‐reported health status 5 levels (1: no problems; 5: extreme problems) |
| Harris 2005 | Self‐reported recovery Difference 0.4 (95% CI ‐2.20 to 3.00) Difference 1.3 (95% CI ‐1.55 to 4.15) | * Short form survey of self‐reported health status 36 items, higher scores better health status T: N = 121, C: N = 120 |
| Richards 1998 | EQ‐5D after adjustment for baseline differences | EQ‐5D |
| Shepperd 1998 | Dartmouth COOP charts Physical fitness Mean difference: 0.06 (95% CI ‐0.32 to 0.43) Mean difference: 0.26 (95% CI ‐0.43 to 0.95) Mean difference: 0.01 (95% CI ‐0.64 to 0.67) | Dartmouth COOP charts Each domain scored 1 ‐ 5 (low score: better quality of life) Mean change at 3 months from baseline Elderly medical patients |
| Tibaldi 2013 | Similar scores for both groups at 1‐month follow‐up | Minnesota Living With Heart Failure Questionnaire Scores 0 ‐ 105; lower scores: better quality of life No data reported |
| Quality of life/self‐reported health status: Older people with COPD | ||
| Ojoo 2002 | Respiratory symptom ‐ Mean (SD) | St George's Respiratory Questionnaire |
| Shepperd 1998 | Dartmouth COOP charts * Physical fitness CRD questionnaire ** | * Dartmouth COOP charts Scale 1 ‐ 5 (low score: better quality of life) Mean change at 3 months from baseline Patients with COPD Feelings ‐ follow‐up data for: ** Chronic Respiratory Disease Questionnaire Treatment n = 10 |
| Skwarska 2000 | No data reported | Chronic Respiratory Questionnaire |
| Utens 2012 | CCQ ‐ Mean (SD) T: 2.70 (1.32); C: 2.41 (1.14) Mean difference: 0.29 (95% CI −0.12 to 0.70) EQ‐5D ‐ Mean change from baseline (SE) T: 0.008 (0.039); C: ‐0.036 (0.0047), P = 0.64 | Clinical COPD Questionnaire 10 items, total score 0 ‐ 6 (higher score: worse health‐related quality of life) Mean change at 3 months from baseline |
| Cognitive functioning | ||
| Caplan 2006 | MMSE * 0.17 95% CI 0.03 to 0.65 | * Mini Mental State Examination (MMSE) 30‐item questionnaire Lower scores: more impairment ** Confusion assessment method for assessing delirium |
| Harris 2005 | MMSE 10‐day ‐ Mean change from baseline (SD) | At 10 days: T: N = 125; C: N = 129 At 30 days: T: N = 117; C: N = 121 At 90 days: T: N = 117; C: N = 109 |
| Martin 1994 | Cognitive status | Abbreviated Mental Test score (0 ‐ 10) Higher score: better outcome No P value given Insufficient data to calculate CI |
| Rada 2008 | Delirium T: 2/29 (6.9%); C: 2/25 (8%), P = 0.88 | Confusion assessment method for assessing delirium |
| Tibaldi 2013 | Similar scores between groups at 1 month follow‐up | MMSE No other data provided |
| Psychological well‐being | ||
| Caplan 2006 | GDS | Geriatric Depression Scale Higher scores: more symptoms of depression |
| Cunliffe 2004 | GHQ 3 months | General Health Questionnaire Higher scores: worse mental health |
| Donald 1995 | Psychological well‐being | Philadelphia Geriatric Center Morale Score Higher score: better outcome No P value given Insufficient data to calculate CI |
| Harris 2005 | FIM ‐ mental subscale 10‐day ‐ Mean change from baseline (SD) | Functional Independence Measure ‐ mental subscale At 10 days: T: N = 134; C: N = 134 At 30 days: T: N = 126; C: N = 125 At 90 days: T: N = 124; C: N = 123 |
| Martin 1994 | Psychological well‐being: | Philadelphia Geriatric Center Morale Score Higher score: better outcome No P value given Insufficient data to calculate CI |
| Shepperd 1998 | Elderly medical patients Psychological well‐being Psychological well‐being Difference ‐0.6 (95% CI ‐3.03 to 1.83) | Philadelphia Geriatric Center Morale Score Higher score: better outcome |
| Tibaldi 2013 | Similar scores between groups at 1‐month follow‐up | Zung Self‐Rating Depression Scale 20 items, score 20 to 80 (higher scores: more depression symptoms) No other data provided |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 7: Patient‐reported outcomes
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 8: Institutional care at 1 year follow‐up (Donald 6 months) ‐ older patients with a mix of conditions
| Patients' place of residence at follow‐up (not included in meta‐analysis) | ||
| Study | Results | Notes |
|---|---|---|
| Martin 1994 | 6 weeks Home Observed difference: 42.7% (95% CI 20% to 66%) Residential care 12 weeks Home T: 21/29 (72%); C: 11/25 (44%) Observed difference 28% (95% CI 3% to 54%) Residential care at 12 weeks | |
| Tibaldi 2013 | At home at 1 month T : 26/26 (100%); C: 23/26 (88%) Difference 12% (95% CI ‐3.3 to 28.9) | |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 9: Patients' place of residence at follow‐up (not included in meta‐analysis)
| Patient satisfaction and preference for place of care | ||
| Study | Results | Notes |
|---|---|---|
| Caplan 2006 | Patient satisfaction ‐ Mean (SD) | 5‐point scale (1 = low, 5 = high) |
| Harris 2005 | Good/excellent rating of the service Did not feel under pressure | 30‐item satisfaction survey (not described) 3 overview questions reported in the paper |
| Ojoo 2002 | Preferred hospital at home T: 26/30 (87%); C: 16/30 (53%) | Questionnaire not described |
| Shepperd 1998 | Elderly medical patients Patient satisfaction | * Patient preference ‐ patients reporting they had received their preferred place of care |
| Skwarska 2000 | 95% of the patients reported being 'completely satisfied' | Treatment group only 79/122 replied to the questionnaire |
| Utens 2012 | Overall satisfaction at 3 months T: 70%; C: 72% Patient preference at 3 months* T: 59%; C: 35% | 3‐part questionnaire: open‐ended questions (3 things patients were more satisfied and dissatisfied about); Quantitative (15 questions about the treatment received); and dichotomous question about preferred place of treatment. Overall score calculated for 41% and 49% of patients in T and C group, respectively. * Percentage of participants preferring to receive treatment at home |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 10: Patient satisfaction and preference for place of care
| Caregiver outcomes | ||
| Study | Results | Notes |
|---|---|---|
| Caplan 2006 | Caregiver satisfaction Mean (SD) | Caregiver satisfaction |
| Cunliffe 2004 | GHQ Mean difference ‐2.0 (95% CI ‐3.8 to ‐0.1) | General Health Questionnaire Higher scores = worse mental health |
| Harris 2005 | Relative satisfaction * Would recommend to others | 30‐item satisfaction survey (not described) * 3 overview questions reported in the paper ** Carer Strain Index 13‐item scale, range 0 ‐ 13 higher score: more strain |
| Ojoo 2002 | Carer preferred hospital at home | |
| Shepperd 1998 | Elderly medical patients Carer Strain Index: Carer Strain Index | Carer Strain Index ‐ mean change from baseline |
| Tibaldi 2013 | Reduction in stress levels at 1 month follow‐up in favour of the treatment group (P = 0.017) | Relative Stress Scale 15 items, scores 0 ‐ 60, higher scores: more stress No other data provided |
| Utens 2012 | Caregiver strain ‐ Mean (SE) T: 3.84 (0.50); C: 3.50 (0.55) Difference ‐0.34 (95% CI ‐1.31 to 1.81) Preference for being cared for at home T: 60%; C: 36%, P = 0.03 | Carer Strain Index 3 months follow‐up |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 11: Caregiver outcomes
| Staff views | ||
| Study | Results | Notes |
|---|---|---|
| Caplan 2006 | General Practitioner satisfaction ‐ Mean (SD) | 5 point scale (1=low, 5=high) |
| Skwarska 2000 | No increase in demand of service: 65% Decreased demand for service: 33% Increased demand in service: 2% | For T group only Questionnaire not described 50% response rate |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 12: Staff views
| Length of stay | ||
| Study | Results | Notes |
|---|---|---|
| Inpatient days (including readmission days) and hospital at home length of stay (not included in meta‐analysis) | ||
| Caplan 2006 | Acute ward inpatient length of stay ‐ Mean (SD) Total length of stay from admission to end of rehabilitation ‐ Mean (SD) T: 34.91 (15.37); C: 40.09 (23.22); P = 0.19 | |
| Cotton 2000 | Initial stay ‐ Mean (range) | |
| Cunliffe 2004 | Length of stay from randomisation to discharge ‐ Median (IQR) [Mean] Visits from EDRS ‐ Median (IQR) [Mean] | |
| Díaz Lobato 2005 | Days in care ‐ Mean T: 9.2; C: 12.2; P < 0.05 | No SD provided P value provided by authors |
| Donald 1995 | Days between randomisation and discharge home ‐ Median | P value provided by authors No data for total days of care |
| Martin 1994 | Hospital length of stay at 12 weeks ‐ Mean | No P value given, insufficient data to calculate CI No data for total days of care |
| Ojoo 2002 | Days in care ‐ Mean | No SD provided P value provided by authors |
| Skwarska 2000 | Total length of stay ‐ Median | Only the treatment group received home visits |
| Total length of stay ‐ hospital plus hospital at home | ||
| Harris 2005 | Total length of stay (IPD) ‐ Mean (SD) | |
| Richards 1998 | Total length of stay ‐ Mean (SD) | T: N = 50; C: N = 25 |
| Shepperd 1998 | Total days of care (hospital plus hospital at home) Elderly medical ‐ Mean (SD) | |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 13: Length of stay
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 14: Hospital length of stay ‐ older people with a mix of conditions
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 15: Total length of stay ‐ older people with a mix of mainly medical conditions
| Cost and resource use | ||
| Study | Results | Notes |
|---|---|---|
| Cost | ||
| Caplan 2006 | Overall Cost | Details of methods used to calculate costs not available. Costs provided in AUD and GBP |
| Cunliffe 2004 | Total mean cost per case at 12 months T: GBP 8361 (GBP 540) ± GBP 1059 C: GBP 10,088 (GBP 713) ± GBP 398 Difference GBP ‐1727, (95% CI ± GBP 2481), P = 0.054 | Healthcare service perspective Resource use quantified using data collected from service providers for 12 months post‐randomisation and on recorded client contact time for hospital at home. Cost of the initial hospital admission and readmissions was estimated based on length of stay and cost/bed day by clinical specialty using NHS costs 2000/2001. Referrals to social services included in the costs. |
| Harris 2005 | Total costs per patient ‐ Mean T: NZD 6524, C: NZD 3525, P < 0.001 | Direct costs of healthcare and support services in 30 days following randomisation. Includes hospital‐related costs (calculated based on expenditure by department) and any payment made by patients for primary care. Costs in New Zealand dollars (NZD) SD not provided by authors, not possible to calculate CI; P value provided by authors |
| Ince 2014 | Total costs per patient ‐ Mean (SD) T: USD 138.57 (USD 72.87): C: USD 951.24 (USD 715.14); P < 0.001 Mean difference: USD ‐812.67 (95% CI ‐1033.33 to ‐592.02) | Total costs per patient for each group, excluding first 24 hours of care Costs in US dollars (USD) |
| Shepperd 1998 | Elderly medical patients Hospital costs per patient Median (IQR); Mean (SD) C: GBP 1366.16 (GBP 629.1 to GBP 2033.5); GBP 1654.2 (GBP 1501.4) Hospital at home costs ‐ Mean (SD) Total health service costs Median (IQR); Mean (SD) P = 0.09 Hospital costs per patient Median (IQR) P = 0.56 Hospital at home costs ‐ Mean (SD) Total health service costs Median (IQR) Median difference GBP 1132.10, P < 0.01 | Mann Whitney U test Health service perspective, dependency scores developed to account for the different resources used during a patient's inpatient admission. Costs calculated at the patient level. Costs at 3 months follow‐up Costs in GBP |
| Skwarska 2000 | Mean cost to the health service T: GBP 877.00, C: GBP 1753 | Cost data financial year 97/98 |
| Utens 2012 | Healthcare costs T: EUR 4129; C: EUR 4297 Difference EUR ‐168 95% (CI ‐1253 to 922) Societal perspective T: EUR 6304; C: EUR 5395 Difference EUR 908 (95% CI ‐552 to 2296) | Costs calculated from healthcare (direct health costs 3 months after randomisation) and societal perspective (direct health costs, non‐healthcare costs and loss of productivity) Costs in euros (EUR) |
| Use of other services | ||
| Cunliffe 2004 | Attending geriatric day hospital T: 6; C: 6.7, P = 0.16 | Results for 12 months follow‐up |
| Martin 1994 | Home care at 6 weeks T: 11/21 (52.4%); C: 3/11 (27.3%) | |
| Rada 2008 | Emergency room visits T: 2/29 (6.9%); C: 0/30 (0%) Observed difference 6.9% (95% CI ‐8.3 to 24.2) | 3 months follow‐up |
Comparison 2: Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 16: Cost and resource use
| Mortality | ||
| Study | Results | Notes |
|---|---|---|
| Karlsson 2016 | T: 21/107 (19.6%); C: 16/98 (16.3%) Difference: ‐3.8% (95% CI ‐19.6% to 23.5%) | Mortality at 12‐month follow‐up |
| Richards 1998 | T: 12/160 (7.5%); C: 6/81 (7.4%) | |
| Shepperd 1998 | Hip replacements | Mortality at 3‐month follow‐up |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 1: Mortality
| Hospital readmission | ||
| Study | Results | Notes |
|---|---|---|
| Crotty 2002 | Recovering from a hip fracture 4 months ‐ Mean (range) | |
| Palmer Hill 2000 | Recovering from a knee replacement Readmission ‐ total | Follow‐up time not specified 4‐month follow‐up for readmission days |
| Richards 1998 | A mix of orthopaedic surgical procedures Mean (SD) T: 5.6 (13.84); C: 4.8 (12.17) Total | Readmission days at 3 months (mix of surgical and medical patients) |
| Ruckley 1978 | Recovering from a hernia or varicose veins At 2 to 3 weeks: | |
| Shepperd 1998 | Knee replacement | 3‐month follow‐up |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 2: Hospital readmission
| Functional status | ||
| Study | Results | Notes |
|---|---|---|
| Crotty 2002 | Modified Barthel Index ‐ Median (range) | Functional status at 4 months (median change from baseline, 25th & 75th percentile) |
| Richards 1998 | Functional status | Barthel Index: 3‐month follow‐up |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 3: Functional status
| Patient outcomes: Quality of life/self‐reported health status | ||
| Study | Results | Notes |
|---|---|---|
| Booth 2004 | SF‐36 PCS ‐ Mean (SD) * | * SF‐36 PCS: Physical component score ** SF‐36 MCS: Mental component score 12‐week follow‐up |
| Crotty 2002 | SF36 PCS ‐ Median (range) T: ‐3.4 (‐14.9 to 8.1); C: ‐3.9 (‐19.5 to 11.7) | |
| Palmer Hill 2000 | Change from baseline, 25th & 75th percentile; no data reported | SF 36 physical component scale |
| Richards 1998 | Dartmouth COOP Charts * Physical fitness | * Dartmouth COOP charts: 5‐point Likert‐type scaling, with descriptors and cartoon illustrations of levels 1 through 5. 1 = no impairment, 5 = most impaired. ** EQ 5D scores: possible range 5 ‐ 15 Scores at 3‐month follow‐up |
| Shepperd 1998 | Hip replacement | HIP REPLACEMENT Treatment = 36 Baseline score measured at 1 month. Scale 12 ‐ 60 (high score: high level of impairment) Treatment = 45 Baseline score done at 1 month Scale 0 ‐ 50 (low score: poor level of functioning) Treatment = 45 |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 4: Patient outcomes: Quality of life/self‐reported health status
| Clinical complications | ||
| Study | Results | Notes |
|---|---|---|
| Adler 1978 | All clinical complications ‐ 7 days post‐surgery | Hernia |
| Booth 2004 | In‐hospital clinical events | |
| Ruckley 1978 | All clinical complications at 2 ‐ 3 weeks | Conditions were combined |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 5: Clinical complications
| Patient satisfaction | ||
| Study | Results | Notes |
|---|---|---|
| Adler 1978 | T: 76/117 (64.9%); C: 62/107 (57.9%) | Results at 14 days follow‐up Patients were asked if they were content with their length of stay in hospital |
| Crotty 2002 | Median score (25th & 75th percentile) | Only 20% of those with a fracture were eligible and agreed to enter trial |
| Richards 1998 | Quality of service (excellent) | Patient satisfaction measured at 4 weeks follow‐up |
| Ruckley 1978 | Advantages seen by patients T: 108/117 (92.3%); C: 95/121 (78.5%) Difference 21.8% (95% CI 11.5% to 32%) | |
| Shepperd 1998 | Hip replacement | * Modified version of satisfaction scale (Pound 1994) Maximum score of 33 (higher score: more satisfied) ** Patient preference: patients reporting they received preferred place of care ^ Resumption of domestic duties/parental responsibilities: patients were asked to agree/disagree on a 0 ‐ 3 scale (3: high level of agreement) |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 6: Patient satisfaction
| Caregiver outcomes | ||
| Study | Results | Notes |
|---|---|---|
| Adler 1978 | Difference between groups reported as significant in favour of the control group | No P value given, insufficient data to calculate CI |
| Crotty 2002 | SF36 Physical component scale ‐ Median (IQR) * T: 1.0 (0 to 4.0); C: 2.0 (0 to 6.8) | 4‐month follow‐up * SF 36, higher score: greater improvement ** Carer Strain Index, a lower score; improvement |
| Ruckley 1978 | Advantages seen by caregivers for others Observed difference: 16.6% (95% CI 6.9% to 26%) Advantages seen by caregivers for patients Advantages seen by caregivers for themselves Observed difference: 10.6% (95% CI 1.2% to 20%) Disadvantages seen by caregivers for themselves Observed difference 22.6% (95% CI 12% to 33%) Disadvantages seen by caregivers for others | Results reported at 1‐week follow‐up |
| Shepperd 1998 | Hip replacement Carer Strain Index ‐ Median Carer Strain Index Carer Strain Index Carer satisfaction Difference ‐0.24 (95% CI ‐0.46 to ‐0.02) | Hip replacement Carer Strain Index Median change from baseline at 3 months Modified version of satisfaction scale (Pound 1994) Scale 0 ‐ 24 (higher score: more satisfied) Caregiver preference: Report of preferred place of care Knee replacement and hysterectomy Mean change from baseline at 3 months Modified version of satisfaction scale (Pound 1994) Scale 0 ‐ 24 (higher score:, more satisfied) Caregiver preference: Report of preferred place of care (knee replacement) |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 7: Caregiver outcomes
| Staff views ‐ GP workload | ||
| Study | Results | Notes |
|---|---|---|
| Adler 1978 | Verbal report | No P value given, insufficient data to calculate CI |
| Crotty 2002 | Visits to GP T: 19/34 (63%); C: 23/32 (77%) | At 4‐month follow‐up |
| Ruckley 1978 | At 3 weeks post‐op | No P value given, insufficient data to calculate CI |
| Shepperd 1998 | Hip replacement | Mann Whitney test |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 8: Staff views ‐ GP workload
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 9: Hospital length of stay ‐ older people recovering from surgery
| Length of stay (not included in meta‐analysis) | ||
| Study | Results | Notes |
|---|---|---|
| Booth 2004 | Total hospital length of stay ‐ Mean (SD) | |
| Richards 1998 | Hospital length of stay Difference 2.39 (95% CI ‐4.39 to 9.17) | Length of stay for patients with a surgical condition (data obtained from authors) (elective surgical centre, acute hospital, in rehabilitative care ‐ published data) Mean (SD) unless stated otherwise |
| Shepperd 1998 | Length of hospital stay Hip replacement Hip replacement | Hospital length of stay Mean (SD) unless stated otherwise Mean (SD) unless stated otherwise |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 10: Length of stay (not included in meta‐analysis)
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 11: Total length of stay ‐ older people having elective surgery
| Cost | ||
| Study | Results | Notes |
|---|---|---|
| Adler 1978 | Social cost (health service, society, patient) | No P value given, insufficient data to calculate CI 1971/72 prices |
| Booth 2004 | Hospital costs for surgery Costs of readmission T: GBP 185; C: GBP 492 T: GBP 58; C: GBP 63 Cost of hospital visits* Total costs at 12 weeks** T: GBP 6127; C: GBP 6381 | Health service perspective Costs estimated for each patient Unit costs obtained from hospital financial figures and published data * includes pre‐admission clinic, inpatient care, and home costs ** include inpatient hospital care, home care, primary care, readmission and home visit costs |
| Richards 1998 | Total cost | No estimates of variance, no test of statistical significance, confidence intervals can not be calculated |
| Ruckley 1978 | Health service costs (for a 48‐hour admission) T: GBP 16 per patient; C: GBP 46 per patient | No P value given, insufficient data to calculate CI 1975/76 prices |
| Shepperd 1998 | Hip replacement Hospital costs ‐ Mean (SD) Hospital at home costs ‐ Mean (SD) Total health service costs ‐ Mean (SD) Hospital costs ‐ Mean (SD) Hospital at home costs ‐ Mean (SD) Total health service costs ‐ Mean (SD) Hospital at home costs ‐ Mean (SD) Total health service costs ‐ Mean (SD) | Cost data financial year 1994/1995 Health service perspective, dependency scores developed to account for the different resources used during a patient's inpatient admission Costs calculated at the patient level |
Comparison 3: Early discharge hospital at home versus inpatient care following elective surgery, Outcome 12: Cost
| Effect of early discharge hospital at home for patients recovering from a stroke | ||||||
| Patient or population: patients recovering from a stroke who otherwise would require acute hospital inpatient care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Without early discharge hospital at home (assumed risk) | With early discharge hospital at home (corresponding risk) | |||||
| Mortality (3 ‐ 6 month follow‐up) | 56 per 1000 | 52 per 1000 | RR 0.92 (0.57 to 1.48) | 1114 (11 trials) | ⊕⊕⊕⊝ | |
| Hospital readmission (3 ‐ 6 month follow‐up) | 187 per 1000 | 204 per 1000 | RR 1.09 (0.71 to 1.66) | 345 (5 trials) | ⊕⊕⊝⊝ | |
| Living in an institutional setting (3 ‐ 6 month follow‐up) | 150 per 1000 | 95 per 1000 | RR 0.63 (0.40 to 0.98) | 574 (4 trials) | ⊕⊕⊝⊝ | |
| Patient satisfaction | Early discharge hospital at home may slightly improve satisfaction with healthcare received for patients recovering from a stroke | ‐ | 795 (6 trials) | ⊕⊕⊝⊝ | ||
| Hospital length of stay | The mean hospital length of stay in the control groups ranged from 16.1 to 42 days | The mean hospital length of stay in the intervention groups was 6.68 lower | MD ‐6.68 (‐10.19 to ‐3.17) | 528 (4 trials) | ⊕⊕⊕⊝ | 5 other randomised trials reported that early discharge hospital at home led to a median reduction in hospital length of stay, ranging from ‐8 days to ‐15 days |
| Cost | It is uncertain if early discharge hospital at home leads to a reduction in costs to the health service | ‐ | 664 participants (4 trials) | ⊕⊝⊝⊝ | ||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Downgraded 1 point for imprecision due to wide CIs. | ||||||
| Effect of early discharge hospital at home for patients with a mix of conditions | ||||||
| Patient or population: older patients with a mix of conditions who otherwise would require acute hospital inpatient care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Without early discharge hospital at home (assumed risk) | With early discharge hospital at home (corresponding risk) | |||||
| Mortality | Patients with a mix of conditions (3 ‐ 6 month follow‐up) | RR 1.07 (0.76 to 1.49) | 1247 (8 trials) | ⊕⊕⊕⊝ | ||
| 93 per 1000 | 100 per 1000 | |||||
| Patients with COPD (2 ‐ 3 month follow‐up) | RR 0.53 (0.25 to 1.12) | 496 (5 trials) | ⊕⊕⊝⊝ | |||
| 69 per 1000 | 35 per 1000 | |||||
| Hospital readmission | Patients with a mix of conditions (3 months follow‐up) | RR 1.25 (0.98 to 1.58) | 1276 (9 trials) | ⊕⊕⊕⊝ | ||
| 148 per 1000 | 191 per 1000 | |||||
| Patients with COPD (3 months follow‐up) | RR 0.86 (0.66 to 1.13) | 496 (5 trials) | ⊕⊕⊝⊝ | |||
| 317 per 1000 | 272 per 1000 | |||||
| Living in an institutional setting (mix of conditions) at 1‐year follow‐up | 233 per 1000 | 161 per 1000 | RR 0.69 (0.48 to 0.99) | 484 (3 trials) | ⊕⊕⊝⊝ | |
| Patient satisfaction | Early discharge hospital at home may slightly improve satisfaction with healthcare received for older people with a mix of healthcare conditions. | ‐ | 900 (6 trials) | ⊕⊕⊝⊝ | ||
| Hospital length of stay | The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day. | 767 (7 trials) | ⊕⊕⊕⊝ | Data were not combined for older people with a medical condition due to variation among study populations and because some of the trials did not provide standard deviation | ||
| Cost | It is uncertain if early discharge hospital at home leads to a reduction in costs to the health service. | ‐ | 1369 (8 trials) | ⊕⊝⊝⊝ | ||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Downgraded 1 points for imprecision due to wide CIs. | ||||||
| Effect of early discharge hospital at home for patients recovering from surgery | ||||||
| Patient or population: patients recovering from surgery who otherwise would require acute hospital inpatient care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Without early discharge hospital at home (assumed risk) | With early discharge hospital at home (corresponding risk) | |||||
| Mortality | Early discharge hospital at home probably leads to little or no difference in mortality | ‐ | 856 (3 trials) | ⊕⊕⊝⊝1 | ||
| Hospital readmission | Early discharge hospital at home probably leads to little or no difference in readmission to hospital | ‐ | 1229 (5 trials) | ⊕⊕⊝⊝1 | ||
| Living in an institutional setting | Data on place of residence at follow‐up were not reported. | ‐ | ‐ | ‐ | ||
| Patient satisfaction | Early discharge hospital at home may slightly improve satisfaction with healthcare received | ‐ | 1229 (5 trials) | ⊕⊕⊝⊝ | ||
| Hospital length of stay (patients recovering from orthopaedic surgery) | The mean hospital length of stay in the control groups ranged from 11.9 to 41.9 | The mean hospital length of stay in the intervention groups was 4.44 lower | MD ‐4.44 (‐6.37 to ‐2.51) | 411 (4 trials) | ⊕⊕⊕⊝ | |
| Cost | It is uncertain if early discharge hospital at home leads to a reduction in costs to the health service. | ‐ | 1129 (5 trials) | ⊕⊝⊝⊝ | ||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Downgraded 2 points due to inconsistency and imprecision. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Mortality at 3 ‐ 6 months Show forest plot | 11 | 1114 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.57, 1.48] |
| 1.2 Mortality at 12 months Show forest plot | 4 | Other data | No numeric data | |
| 1.3 Hospital readmission at 3 ‐ 6 months Show forest plot | 5 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.71, 1.66] |
| 1.4 Hospital readmission at 12 months follow‐up Show forest plot | 2 | Other data | No numeric data | |
| 1.5 Functional status Show forest plot | 10 | Other data | No numeric data | |
| 1.6 Patient outcomes Show forest plot | 8 | Other data | No numeric data | |
| 1.6.1 Quality of life/self‐reported health status | 7 | Other data | No numeric data | |
| 1.6.2 Psychological well‐being | 2 | Other data | No numeric data | |
| 1.7 Institutional care at 6 months follow‐up (Rodgers 3‐month data) Show forest plot | 4 | 574 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.40, 0.98] |
| 1.8 Patient satisfaction and preference for place of care Show forest plot | 6 | Other data | No numeric data | |
| 1.9 Caregiver outcomes Show forest plot | 5 | Other data | No numeric data | |
| 1.10 Hospital length of stay Show forest plot | 4 | 528 | Mean Difference (IV, Fixed, 95% CI) | ‐6.68 [‐10.19, ‐3.17] |
| 1.11 Length of stay: inpatient days (including readmission days) and home‐based treatment Show forest plot | 9 | Other data | No numeric data | |
| 1.12 Cost and use of other services Show forest plot | 5 | Other data | No numeric data | |
| 1.12.1 Cost | 4 | Other data | No numeric data | |
| 1.12.2 Use of other services | 3 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Mortality at 3 ‐ 6 months ‐ older people with a mix of conditions Show forest plot | 8 | 1247 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.76, 1.49] |
| 2.2 Mortality ‐ chronic obstructive pulmonary disease Show forest plot | 5 | 496 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.25, 1.12] |
| 2.3 Hospital readmission at 3 months ‐ older people with a mix of conditions Show forest plot | 9 | 1276 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.25 [0.98, 1.58] |
| 2.4 Hospital readmission for those with COPD Show forest plot | 5 | 496 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.66, 1.13] |
| 2.5 Functional status ‐ older people a mix of conditions, including COPD Show forest plot | 8 | Other data | No numeric data | |
| 2.5.1 Functional status | 8 | Other data | No numeric data | |
| 2.5.2 Falls | 1 | Other data | No numeric data | |
| 2.6 Functional status at 3 months ‐ older people with a mix of conditions Show forest plot | 4 | 639 | Mean Difference (IV, Fixed, 95% CI) | 0.34 [‐0.18, 0.86] |
| 2.7 Patient‐reported outcomes Show forest plot | 12 | Other data | No numeric data | |
| 2.7.1 Quality of life/self‐reported health status: Older people with a mix of conditions | 5 | Other data | No numeric data | |
| 2.7.2 Quality of life/self‐reported health status: Older people with COPD | 4 | Other data | No numeric data | |
| 2.7.3 Cognitive functioning | 5 | Other data | No numeric data | |
| 2.7.4 Psychological well‐being | 7 | Other data | No numeric data | |
| 2.8 Institutional care at 1 year follow‐up (Donald 6 months) ‐ older patients with a mix of conditions Show forest plot | 3 | 484 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.48, 0.99] |
| 2.9 Patients' place of residence at follow‐up (not included in meta‐analysis) Show forest plot | 2 | Other data | No numeric data | |
| 2.10 Patient satisfaction and preference for place of care Show forest plot | 6 | Other data | No numeric data | |
| 2.11 Caregiver outcomes Show forest plot | 7 | Other data | No numeric data | |
| 2.12 Staff views Show forest plot | 2 | Other data | No numeric data | |
| 2.13 Length of stay Show forest plot | 11 | Other data | No numeric data | |
| 2.13.1 Inpatient days (including readmission days) and hospital at home length of stay (not included in meta‐analysis) | 8 | Other data | No numeric data | |
| 2.13.2 Total length of stay ‐ hospital plus hospital at home | 3 | Other data | No numeric data | |
| 2.14 Hospital length of stay ‐ older people with a mix of conditions Show forest plot | 4 | 613 | Mean Difference (IV, Fixed, 95% CI) | ‐6.76 [‐10.60, ‐2.92] |
| 2.15 Total length of stay ‐ older people with a mix of mainly medical conditions Show forest plot | 3 | 378 | Mean Difference (IV, Fixed, 95% CI) | 6.43 [2.84, 10.03] |
| 2.16 Cost and resource use Show forest plot | 9 | Other data | No numeric data | |
| 2.16.1 Cost | 7 | Other data | No numeric data | |
| 2.16.2 Use of other services | 3 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Mortality Show forest plot | 3 | Other data | No numeric data | |
| 3.2 Hospital readmission Show forest plot | 5 | Other data | No numeric data | |
| 3.3 Functional status Show forest plot | 2 | Other data | No numeric data | |
| 3.4 Patient outcomes: Quality of life/self‐reported health status Show forest plot | 5 | Other data | No numeric data | |
| 3.5 Clinical complications Show forest plot | 3 | Other data | No numeric data | |
| 3.6 Patient satisfaction Show forest plot | 5 | Other data | No numeric data | |
| 3.7 Caregiver outcomes Show forest plot | 4 | Other data | No numeric data | |
| 3.8 Staff views ‐ GP workload Show forest plot | 4 | Other data | No numeric data | |
| 3.9 Hospital length of stay ‐ older people recovering from surgery Show forest plot | 4 | 411 | Mean Difference (IV, Fixed, 95% CI) | ‐4.44 [‐6.37, ‐2.51] |
| 3.10 Length of stay (not included in meta‐analysis) Show forest plot | 3 | Other data | No numeric data | |
| 3.11 Total length of stay ‐ older people having elective surgery Show forest plot | 2 | 245 | Mean Difference (IV, Fixed, 95% CI) | 2.79 [0.77, 4.81] |
| 3.12 Cost Show forest plot | 5 | Other data | No numeric data | |
