Hospital at home for acute exacerbations of chronic obstructive pulmonary disease

Felix SF Ram; Jadwiga A Wedzicha; John J Wright; Michael Greenstone

doi:10.1002/14651858.CD003573

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Figure 1

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

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Figure 2

Forest plot of comparison: 1 Hospital at Home versus Standard Inpatient Care, outcome: 1.3 Mortality.

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Analysis 1.1

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 1 Hospital in‐patient readmissions.

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Analysis 1.2

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 2 Hospital emergency room visit only (with no in‐patient admission).

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Analysis 1.3

Comparison 1 Hospital at Home versus Standard Inpatient Care, Outcome 3 Mortality.

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Analysis 2.1

Comparison 2 Lung function, Outcome 1 FEV1.

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Analysis 2.2

Comparison 2 Lung function, Outcome 2 FVC.

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Analysis 2.3

Comparison 2 Lung function, Outcome 3 FEV1/FVC %.

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Analysis 3.1

Comparison 3 Health related quality of life scores, Outcome 1 SGRQ (higher negative score is better).

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Analysis 4.1

Comparison 4 Satisfaction with care, Outcome 1 Satisfaction with care.

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Analysis 5.1

Comparison 5 Preference for type of care, Outcome 1 Preference for "Hospital at home care".

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Analysis 6.1

Comparison 6 Economic costs, Outcome 1 Average cost.

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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 in‐patient readmissions Show forest plot	7	754	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.72, 1.12]

2 Hospital emergency room visit only (with no in‐patient admission) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Mortality Show forest plot	6	729	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.36, 1.05]

Comparison 1. Hospital at Home versus Standard Inpatient Care

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Comparison 2. Lung function

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV1 Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Change post‐bronchodilator (L)	1	150	Mean Difference (IV, Fixed, 95% CI)	‐0.03 [‐0.14, 0.08]
1.2 Change from baseline (L)	1	60	Mean Difference (IV, Fixed, 95% CI)	0.1 [‐0.03, 0.23]
1.3 Actual value at end of study (L)	1	222	Mean Difference (IV, Fixed, 95% CI)	0.10 [‐0.03, 0.23]
2 FVC Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Change from baseline (L)	1	60	Mean Difference (IV, Fixed, 95% CI)	0.05 [‐0.25, 0.35]
2.2 Actual value at end of study (L)	1	222	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐0.04, 0.44]
3 FEV1/FVC % Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 2. Lung function

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Comparison 3. Health related quality of life scores

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 SGRQ (higher negative score is better) Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Percentage improvement (discharge ‐ initial admission score)	1	60	Mean Difference (IV, Fixed, 95% CI)	‐0.5 [‐8.20, 7.20]
1.2 Mean change (discharge ‐ initial admission score)	2	272	Mean Difference (IV, Fixed, 95% CI)	2.83 [‐6.09, 11.75]

Comparison 3. Health related quality of life scores

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Comparison 4. Satisfaction with care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Satisfaction with care Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Patient satisfaction	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Carer satisfaction	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Satisfaction with care

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Comparison 5. Preference for type of care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Preference for "Hospital at home care" Show forest plot	2	152	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [1.23, 1.90]

1.1 Patient preference	2	86	Risk Ratio (M‐H, Fixed, 95% CI)	1.54 [1.17, 2.04]
1.2 Carer preference	2	66	Risk Ratio (M‐H, Fixed, 95% CI)	1.52 [1.08, 2.14]

Comparison 5. Preference for type of care

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Comparison 6. Economic costs

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Average cost Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Direct cost per patient (Euros)	2	235	Mean Difference (IV, Fixed, 95% CI)	‐813.04 [‐818.91, ‐807.18]
1.2 Direct cost per patient (£ ‐ pound sterling)	2	235	Mean Difference (IV, Fixed, 95% CI)	‐536.78 [‐540.65, ‐532.91]

Comparison 6. Economic costs

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