Hospital at home for acute exacerbations of chronic obstructive pulmonary disease

Elisabeth Jeppesen; Kjetil G Brurberg; Gunn E Vist; Jadwiga A Wedzicha; John J Wright; Michael Greenstone; Julia AE Walters

doi:10.1002/14651858.CD003573.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Editoriales
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Editoriales

Topics

Temas

Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Forest plot of comparison: 1 Hospital at Home versus Standard Inpatient Care, outcome: 1.1 Hospital inpatient readmissions.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Forest plot of comparison: 1 Hospital at Home versus Standard Inpatient Care, outcome: 1.2 Mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 1 Hospital inpatient readmissions.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 2 Mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 3 FEV1 (lung function).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 4 FVC (lung function).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 5 FEV1/FVC % (lung function).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 6 Health‐related quality of life measured with SGRQ.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 7 Satisfaction with care.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 8 Preference for "Hospital at home care".

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 9 Average direct costs per patients.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Hospital at home for exacerbations of COPD

Hospital at home for exacerbations of COPD
Patient or population: exacerbations of COPD Intervention: Hospital at home ‐ regular home visits by trained respiratory nurse supported by hospital team Control: usual care in hospital
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Hospital at home
Readmission to hospital, inpatient. Number of people experiencing one or more readmissions (follow‐up: 1 to 6 months)	36 readmissions to hospital per 100	9 fewer readmissions per 100 (15 fewer to 0 fewer)	RR 0.76 (0.59 to 0.99)	870 (8 studies)	⊕⊕⊕⊝ moderate^1,2
Mortality (follow‐up: 2 to 6 months)	10 deaths per 100	3 fewer deaths per 100 (6 fewer to 0 more)	RR 0.65 (0.4 to 1.04)	845 (7 studies)	⊕⊕⊕⊝ moderate²
Patient satisfaction Number of people stating to be very satisfied with treatment (follow‐up: 0 to 2 weeks after discharge)	89 per 100	5 more very satisfied patient per 100 (4 fewer to 15 more)	RR 1.06 (0.96 to 1.17)	158 (2 studies)	⊕⊕⊝⊝ low^3,4
Carer satisfaction Number of carers stating to be very satisfied with treatment (follow‐up: 2 weeks after discharge)	93 per 100	3 fewer very satisfied carers per 100 (20 fewer to 18 more)	RR 0.97 (0.79 to 1.19)	34 (1 study)	⊕⊝⊝⊝ very low^3,4,5
FEV1 litres		Mean FEV1 in the intervention groups was 0.13 standard deviations higher (0.10 lower to 0.36 higher)		432 (3 studies)	⊕⊕⊝⊝ low^2,3
Quality of life SGRQ (follow‐up: at discharge)	See comment	See comment	See comment	332 (3 studies)	⊕⊝⊝⊝ very low^2,3	One trial did not report standard deviations, and one study only provided SGRQ scores for a subgroup of 50 participants. This can introduce bias into the overall combined result, and we decided not to combine the results in meta‐analysis.
Direct costs (follow‐up: 1 to 6 months)	See comment	See comment	See comment	339 (3 studies)	⊕⊝⊝⊝ very low^6,7	The trials were carried out in different years and countries, and reported different currencies. We considered it inappropriate to pool the results in meta‐analysis.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ We did not downgrade due to inconsistency, although some heterogeneity was encountered (I² = 34 %, removing the study at high risk of bias reduced heterogeneity to I² = 16 %) ² We downgraded one for imprecision due to a wide confidence interval ³ We downgraded as this was a subjective outcome at high risk of bias as patients or carers were not blinded (not possible) ⁴ We downgraded one for imprecision as there were few events and people ⁵ We downgraded one for imprecision as there was a single study only ⁶ We downgraded one due to unexplained heterogeneity ⁷ We downgraded two due to different countries and conditions (indirectness)

Summary of findings for the main comparison. Hospital at home for exacerbations of COPD

Ir a la tabla de la revisión

Table 1. Percentage recruitment (number of patients entered into trial / total screened)

Study Reference	Total recruited	Total screened	Percentage
Cotton 2000	81	360	22.5
Davies 2000	150	583	25.7
Hernandez 2003	244	629	38.7
Nicholson 2001	25	168	14.8
Nissen 2007	44	390	11.3
Ojoo 2002	60	328	18.2
Ricauda 2008	104	529	19.7
Skwarska 2000	184	718	25.6

TOTALS	744	2786	26.7

Table 1. Percentage recruitment (number of patients entered into trial / total screened)

Ir a la tabla de la revisión

Comparison 1. Hospital at Home versus Standard Inpatient Care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hospital inpatient readmissions Show forest plot	8	870	Risk Ratio (M‐H, Random, 95% CI)	0.76 [0.59, 0.99]

2 Mortality Show forest plot	7	845	Risk Ratio (M‐H, Random, 95% CI)	0.65 [0.40, 1.04]

3 FEV1 (lung function) Show forest plot	3	432	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.10, 0.36]

3.1 Change post‐bronchodilator (L)	1	150	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.43, 0.25]
3.2 Change from baseline (L)	1	60	Std. Mean Difference (IV, Random, 95% CI)	0.37 [‐0.14, 0.88]
3.3 Actual value at end of study (L)	1	222	Std. Mean Difference (IV, Random, 95% CI)	0.19 [‐0.07, 0.46]
4 FVC (lung function) Show forest plot	2	282	Mean Difference (IV, Random, 95% CI)	0.14 [‐0.04, 0.33]

4.1 Change from baseline (L)	1	60	Mean Difference (IV, Random, 95% CI)	0.05 [‐0.25, 0.35]
4.2 Actual value at end of study (L)	1	222	Mean Difference (IV, Random, 95% CI)	0.20 [‐0.04, 0.44]
5 FEV1/FVC % (lung function) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

6 Health‐related quality of life measured with SGRQ Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

6.1 Percentage improvement (discharge ‐ initial admission score)	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Mean change (discharge ‐ initial admission score)	2		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7 Satisfaction with care Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

7.1 Patient satisfaction	2	158	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.96, 1.17]
7.2 Carer satisfaction	1	34	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.79, 1.19]
8 Preference for "Hospital at home care" Show forest plot	1	88	Risk Ratio (M‐H, Random, 95% CI)	1.69 [1.27, 2.25]

8.1 Patient preference	1	54	Risk Ratio (M‐H, Random, 95% CI)	1.63 [1.18, 2.24]
8.2 Carer preference	1	34	Risk Ratio (M‐H, Random, 95% CI)	1.98 [1.05, 3.73]
9 Average direct costs per patients Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Totals not selected

9.1 Euro [1000 €]	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9.2 USD [1000 $]	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9.3 AUD [1000 $]	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Hospital at Home versus Standard Inpatient Care

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet