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Comparison 1 NLU vs general inpatient care, Outcome 1 Inpatient mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 NLU vs general inpatient care, Outcome 1 Inpatient mortality.

Comparison 1 NLU vs general inpatient care, Outcome 2 Early post discharge death (4‐6 weeks).
Figuras y tablas -
Analysis 1.2

Comparison 1 NLU vs general inpatient care, Outcome 2 Early post discharge death (4‐6 weeks).

Comparison 1 NLU vs general inpatient care, Outcome 3 Mortality within 3 months of admission (12 weeks / 90 days).
Figuras y tablas -
Analysis 1.3

Comparison 1 NLU vs general inpatient care, Outcome 3 Mortality within 3 months of admission (12 weeks / 90 days).

Comparison 1 NLU vs general inpatient care, Outcome 4 Mortality within 6 months of admission (24 weeks / 180 days).
Figuras y tablas -
Analysis 1.4

Comparison 1 NLU vs general inpatient care, Outcome 4 Mortality within 6 months of admission (24 weeks / 180 days).

Comparison 1 NLU vs general inpatient care, Outcome 5 Mortality to longest follow up (within 6 months).
Figuras y tablas -
Analysis 1.5

Comparison 1 NLU vs general inpatient care, Outcome 5 Mortality to longest follow up (within 6 months).

Comparison 1 NLU vs general inpatient care, Outcome 6 Discharge to institutional care.
Figuras y tablas -
Analysis 1.6

Comparison 1 NLU vs general inpatient care, Outcome 6 Discharge to institutional care.

Comparison 1 NLU vs general inpatient care, Outcome 7 Independent at discharge.
Figuras y tablas -
Analysis 1.7

Comparison 1 NLU vs general inpatient care, Outcome 7 Independent at discharge.

Comparison 1 NLU vs general inpatient care, Outcome 8 Institutional care to longest follow up.
Figuras y tablas -
Analysis 1.8

Comparison 1 NLU vs general inpatient care, Outcome 8 Institutional care to longest follow up.

Comparison 1 NLU vs general inpatient care, Outcome 9 Functional Status.
Figuras y tablas -
Analysis 1.9

Comparison 1 NLU vs general inpatient care, Outcome 9 Functional Status.

Comparison 1 NLU vs general inpatient care, Outcome 10 Change in functional Status (admission to discharge).
Figuras y tablas -
Analysis 1.10

Comparison 1 NLU vs general inpatient care, Outcome 10 Change in functional Status (admission to discharge).

Comparison 1 NLU vs general inpatient care, Outcome 11 Length of stay to first discharge from hospital setting.
Figuras y tablas -
Analysis 1.11

Comparison 1 NLU vs general inpatient care, Outcome 11 Length of stay to first discharge from hospital setting.

Comparison 1 NLU vs general inpatient care, Outcome 12 Length of stay to first discharge home.
Figuras y tablas -
Analysis 1.12

Comparison 1 NLU vs general inpatient care, Outcome 12 Length of stay to first discharge home.

Comparison 1 NLU vs general inpatient care, Outcome 13 Early readmission (within 30 days).
Figuras y tablas -
Analysis 1.13

Comparison 1 NLU vs general inpatient care, Outcome 13 Early readmission (within 30 days).

Comparison 1 NLU vs general inpatient care, Outcome 14 Quality of life / health status.
Figuras y tablas -
Analysis 1.14

Comparison 1 NLU vs general inpatient care, Outcome 14 Quality of life / health status.

Comparison 1 NLU vs general inpatient care, Outcome 15 Quality of life / health status change scores only.
Figuras y tablas -
Analysis 1.15

Comparison 1 NLU vs general inpatient care, Outcome 15 Quality of life / health status change scores only.

Comparison 1 NLU vs general inpatient care, Outcome 16 Psychological wellbeing.
Figuras y tablas -
Analysis 1.16

Comparison 1 NLU vs general inpatient care, Outcome 16 Psychological wellbeing.

Comparison 1 NLU vs general inpatient care, Outcome 17 Satisfaction.
Figuras y tablas -
Analysis 1.17

Comparison 1 NLU vs general inpatient care, Outcome 17 Satisfaction.

Comparison 2 NLU vs ICU, Outcome 1 Inpatient mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 NLU vs ICU, Outcome 1 Inpatient mortality.

Comparison 2 NLU vs ICU, Outcome 2 Mortality to longest follow up (Up to 24 months).
Figuras y tablas -
Analysis 2.2

Comparison 2 NLU vs ICU, Outcome 2 Mortality to longest follow up (Up to 24 months).

Comparison 2 NLU vs ICU, Outcome 3 Discharge to institutional care.
Figuras y tablas -
Analysis 2.3

Comparison 2 NLU vs ICU, Outcome 3 Discharge to institutional care.

Comparison 2 NLU vs ICU, Outcome 4 Length of stay to first discharge home.
Figuras y tablas -
Analysis 2.4

Comparison 2 NLU vs ICU, Outcome 4 Length of stay to first discharge home.

Comparison 2 NLU vs ICU, Outcome 5 Early readmission (within 30 days).
Figuras y tablas -
Analysis 2.5

Comparison 2 NLU vs ICU, Outcome 5 Early readmission (within 30 days).

Table 1. Summary of study validity

Study ID

Method

Concealment

Follow Up

Blinded assessment

Baseline

Reliable assessment

Contamination

Intention to treat

Number (3‐7) 'done'

Bowcutt 2000

RCT

Unclear

Done

*

Unclear

*

Done

Unclear

2 /5

Daly 1995

CCT

Not done

Done

Unclear

Done

Done

Done

Unclear

4/7

Davies 1994

CBA

Unclear

Unclear

Unclear

Unclear

0/4

Griffiths 1995

RCT

Not done

Done

Not done

Not done

Not done

Done

Done

3/7

Griffiths 2000

RCT

Not done

Done

Not done

Done

Done

Done

Done

5/7

Griffiths 2001

RCT

Done

Done

Not done

Done

Done

Done

Done

6/7

Hall 1975

CCT

Unclear

Done

Not done

Not done

Unclear

Unclear

Done

2/7

Pearson 1988a

RCT

Done

Done

Not done

Not done

Unclear

Done

Unclear

3/7

Pearson 1988b

RCT

Done

Done

Not done

Not done

Unclear

Done

Not done

3/7

Steiner 2001

RCT

Not done

Done

Unclear

Done

Unclear

Done

Done

4/7

Walsh 1999

RCT

Done

Done

Unclear

Unclear

Unclear

Done

Done

4/7

Figuras y tablas -
Table 1. Summary of study validity
Table 2. Costs of care ‐ in‐patient

Study id

Costs considered

Treatment cost

Control cost

Notes

Griffiths 2001

In‐patient costs to service providers (from study entry)

£5144 per stay

£4100 per stay

Comprehensive range of resources used identified and costed directly or estimated. Used a variety of methods to estimate total inpatient costs (including medical and nursing care). Cost differences were subjected to a sensitivity analysis and were not sensitive to assumptions. Main driver of costs is length of stay.

Griffiths 2000

In‐patient costs to service providers (from study entry)

High estimate £ 10,278, Low estimate £8,544 per stay

£7,757

Comprehensive range of resources used identified and costed directly or estimated. Used two methods to estimate cost of medical care for NLU. Magnitude of cost difference varied depending on this but NLU more expensive. Main driver of costs is length of stay.

Bowcutt 2000

Direct hospital costs ‐ unspecified

$9,445.06

$19.,320.87

No detail given on costs other than nursing staff

Pearson 1988a

Cost per hospital stay (including acute stay) to service providers

£1267.3 (£1323.6*)

£1311.9

No detail given on costs other than nursing staff. *Figure in brackets recalculated from data given in paper.

Pearson 1988b

Cost per hospital stay (including acute stay) to service providers

£1476.36

£1431.42

Costing based on staff cost and average cost per bed (estimated)

Daly 1995

In‐patient costs to service providers (total stay)

$76,077

$81,212

Comprehensive range of resources used identified and costed directly or estimated..

Steiner 2001

In‐patient costs to service providers (from study entry)

£7892

£4910

Unclear if aggregate daily cost of NLU reflects resources actually used

Figuras y tablas -
Table 2. Costs of care ‐ in‐patient
Table 3. Costs of care post discharge

Study ID

Costs considered

Treatment cost

Control cost

Notes

Griffiths 2001

Community health and social services cost and post discharge institutional charges to public providers

£374.91 per week

£401.60 per week

Comprehensive range of service provider costs identified. Resource use estimated based on planned resource use identified in patients discharge plan

Griffiths 2000

Health and social services cost and post discharge institutional charges to public providers in the month after discharge

All costs £990, community health and social services only £162

All costs £1,259, community health and social services only £253

Comprehensive range of service provider costs identified. Resource use determined directly from a sample supplemented by estimates based on planned resource use identified in patients discharge plan. Total costs include costs of readmissions

Steiner 2001

Inpatient and community health services cost and post discharge institutional charges to public providers over six months from entry into the study

Total £10,529 of which £1444 post discharge

Total £7819 of which £1879 post discharge

Comprehensive range of service provider costs identified over six months from initial entry to the study. Total costs include costs of readmissions

Figuras y tablas -
Table 3. Costs of care post discharge
Comparison 1. NLU vs general inpatient care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Inpatient mortality Show forest plot

7

953

Odds Ratio (M‐H, Random, 95% CI)

1.10 [0.56, 2.16]

1.1 Stronger studies

4

607

Odds Ratio (M‐H, Random, 95% CI)

1.52 [0.86, 2.68]

1.2 Weaker studies

3

346

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.13, 3.46]

2 Early post discharge death (4‐6 weeks) Show forest plot

4

892

Odds Ratio (M‐H, Random, 95% CI)

0.63 [0.25, 1.62]

2.1 Stronger studies

1

153

Odds Ratio (M‐H, Random, 95% CI)

0.44 [0.08, 2.49]

2.2 Weaker studies

3

739

Odds Ratio (M‐H, Random, 95% CI)

0.74 [0.24, 2.24]

3 Mortality within 3 months of admission (12 weeks / 90 days) Show forest plot

3

885

Odds Ratio (M‐H, Random, 95% CI)

1.60 [0.93, 2.75]

3.1 Stronger studies

2

352

Odds Ratio (M‐H, Random, 95% CI)

1.52 [0.82, 2.82]

3.2 Weaker studies

1

533

Odds Ratio (M‐H, Random, 95% CI)

1.88 [0.61, 5.80]

4 Mortality within 6 months of admission (24 weeks / 180 days) Show forest plot

3

946

Odds Ratio (M‐H, Random, 95% CI)

0.96 [0.63, 1.47]

4.1 Stronger studies

2

413

Odds Ratio (M‐H, Random, 95% CI)

0.95 [0.58, 1.56]

4.2 Weaker studies

1

533

Odds Ratio (M‐H, Random, 95% CI)

1.00 [0.46, 2.20]

5 Mortality to longest follow up (within 6 months) Show forest plot

6

1350

Odds Ratio (M‐H, Random, 95% CI)

0.92 [0.65, 1.29]

5.1 Stronger studies

3

590

Odds Ratio (M‐H, Random, 95% CI)

1.08 [0.71, 1.65]

5.2 Weaker studies

3

760

Odds Ratio (M‐H, Random, 95% CI)

0.70 [0.37, 1.34]

6 Discharge to institutional care Show forest plot

7

952

Odds Ratio (M‐H, Random, 95% CI)

0.44 [0.22, 0.89]

6.1 stronger studies

4

529

Odds Ratio (M‐H, Random, 95% CI)

0.83 [0.41, 1.67]

6.2 Weaker studies

3

423

Odds Ratio (M‐H, Random, 95% CI)

0.24 [0.12, 0.49]

7 Independent at discharge Show forest plot

6

861

Odds Ratio (M‐H, Fixed, 95% CI)

0.71 [0.53, 0.95]

7.1 stronger studies

4

586

Odds Ratio (M‐H, Fixed, 95% CI)

1.04 [0.72, 1.50]

7.2 Weaker studies

2

275

Odds Ratio (M‐H, Fixed, 95% CI)

0.36 [0.22, 0.59]

8 Institutional care to longest follow up Show forest plot

3

411

Odds Ratio (M‐H, Random, 95% CI)

0.97 [0.60, 1.58]

8.1 Stronger studies

3

411

Odds Ratio (M‐H, Random, 95% CI)

0.97 [0.60, 1.58]

9 Functional Status Show forest plot

6

762

Std. Mean Difference (IV, Random, 95% CI)

0.35 [0.16, 0.53]

9.1 Stronger studies

4

540

Std. Mean Difference (IV, Random, 95% CI)

0.22 [0.05, 0.39]

9.2 Weaker studies

2

222

Std. Mean Difference (IV, Random, 95% CI)

0.61 [0.34, 0.88]

10 Change in functional Status (admission to discharge) Show forest plot

5

638

Std. Mean Difference (IV, Random, 95% CI)

0.32 [0.11, 0.54]

10.1 Strong

4

540

Std. Mean Difference (IV, Random, 95% CI)

0.22 [0.05, 0.39]

10.2 Weak

1

98

Std. Mean Difference (IV, Random, 95% CI)

0.77 [0.35, 1.18]

11 Length of stay to first discharge from hospital setting Show forest plot

9

1669

Mean Difference (IV, Random, 95% CI)

7.37 [2.86, 11.88]

11.1 Stronger studies

4

607

Mean Difference (IV, Random, 95% CI)

13.41 [8.54, 18.29]

11.2 Weaker Studies

5

1062

Mean Difference (IV, Random, 95% CI)

4.08 [‐0.97, 9.13]

12 Length of stay to first discharge home Show forest plot

8

1478

Mean Difference (IV, Random, 95% CI)

5.13 [‐0.50, 10.76]

12.1 Stronger studies

4

607

Mean Difference (IV, Random, 95% CI)

8.78 [2.93, 14.63]

12.2 Weaker Studies

4

871

Mean Difference (IV, Random, 95% CI)

‐1.37 [‐13.52, 10.79]

13 Early readmission (within 30 days) Show forest plot

5

1126

Odds Ratio (M‐H, Random, 95% CI)

0.52 [0.34, 0.80]

13.1 Stronger studies

3

493

Odds Ratio (M‐H, Random, 95% CI)

0.63 [0.36, 1.12]

13.2 Weaker studies

2

633

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.21, 0.76]

14 Quality of life / health status Show forest plot

5

448

Std. Mean Difference (IV, Random, 95% CI)

0.28 [0.09, 0.48]

14.1 Stronger studies

2

238

Std. Mean Difference (IV, Random, 95% CI)

0.33 [‐0.01, 0.67]

14.2 Weaker studies

3

210

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.07, 0.51]

15 Quality of life / health status change scores only Show forest plot

3

275

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.15, 0.59]

15.1 Stronger studies

2

238

Std. Mean Difference (IV, Random, 95% CI)

0.33 [‐0.01, 0.67]

15.2 Weaker studies

1

37

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.12, 0.53]

16 Psychological wellbeing Show forest plot

3

280

Std. Mean Difference (IV, Random, 95% CI)

0.36 [‐0.03, 0.74]

16.1 Stronger studies

2

244

Std. Mean Difference (IV, Random, 95% CI)

0.25 [‐0.03, 0.52]

16.2 Weaker studies

1

36

Std. Mean Difference (IV, Random, 95% CI)

1.04 [0.17, 1.90]

17 Satisfaction Show forest plot

4

335

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.03, 0.46]

17.1 Stronger studies

2

175

Std. Mean Difference (IV, Random, 95% CI)

0.19 [‐0.11, 0.48]

17.2 Weaker Studies

2

160

Std. Mean Difference (IV, Random, 95% CI)

0.29 [‐0.15, 0.72]

Figuras y tablas -
Comparison 1. NLU vs general inpatient care
Comparison 2. NLU vs ICU

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Inpatient mortality Show forest plot

1

220

Odds Ratio (M‐H, Random, 95% CI)

0.62 [0.35, 1.10]

2 Mortality to longest follow up (Up to 24 months) Show forest plot

1

152

Odds Ratio (M‐H, Random, 95% CI)

0.80 [0.40, 1.59]

3 Discharge to institutional care Show forest plot

1

145

Odds Ratio (M‐H, Random, 95% CI)

0.61 [0.30, 1.25]

4 Length of stay to first discharge home Show forest plot

1

220

Mean Difference (IV, Random, 95% CI)

‐2.0 [‐10.96, 6.96]

5 Early readmission (within 30 days) Show forest plot

1

145

Odds Ratio (M‐H, Random, 95% CI)

0.33 [0.12, 0.94]

Figuras y tablas -
Comparison 2. NLU vs ICU