Hospital at home admission avoidance

Comparison 1. Admission avoidance hospital at home versus inpatient care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Functional ability Show forest plot

Other data

No numeric data

Analysis 1.1


Study	Functional ability	Results	Notes
Admission avoidance patients recovering from a stroke functional ability
Kalra 2000	Modified Rankin scale 0‐3 (measure of dependence: 0=independent and 3=dependent). Number independent and require minor assistance for day to day activities. Barthel 0‐20 (higher score=greater independence)	Modified Rankin At 3 months T=107/145 (74%) C=111/151 (74%) RR 1.00 (0.86, 1.15) P=0.96 At 12 months T=102/144 (71%) C=99/149 (66%) RR 0.94 (0.81, 1.09) P=0.42 Barthel 15‐20 (number with favourable outcome) At 3 months T=106/145 (73%) C=106/151 (70%) RR 0.96 (0.83, 1.11) P=0.58 At 12 months T=102/144 (71%) C=102/149 (69%) RR 0.97 (0.85, 1.11) P=0.65
Ricauda 2004	Activities of daily living (number of functions lost, score 0 to 6). Functional impairment measure (level of independence, range 28 to 126 with high score =greater independence). Canadian Neurological Scale Score (higher score=improvement, range 0‐10) National Institute of Health Stroke Scale Score (low score =improvement; range 0‐36)	Activities of daily living (scale 0 to 6) At 6 months Median IQR T=4 (2‐5) C=4 (2‐6) P=0.57 (Mann Whitney) Functional impairment measure (range 28 to 126) At 6 months Median IQR T=106 (67.5‐121.5) C=96.5 (56.5‐116.5) P=0.26 (Mann Whitney) Canadian Neurological Scale Score (range 0‐10) At 6 months Median IQR T=10 (8.5‐10.0) C=9.5 (7.0‐10.0) P=0.39 (Mann Whitney National Institute of Health Stroke Scale Score (range 0‐36) At 6 months Median IQR T=8 (4‐26) C=8 (6‐24) P=0.37 (Mann Whitney)
Admission avoidance patients with a medical condition ‐ functional ability
Caplan 1999	Change in Barthel score from admission to discharge (high score=greater independence) Instrumental activities of daily living score from admission to discharge (higher score=greater independence)	Mean (SEM) T= 0.37 (0.27) C= ‐0.04 (0.27) NS Mean (SEM) T=0.65 (0.23) C=‐0.88 (0.26) P=0.037
Davies 2000	St Georges' respiratory questionnaire: high score indicates poorer health related quality of life Forced expiratory volume in one second (FEV1):	Baseline scores Treatment: 71.5 (43.4 to 99.6) Control: 71 (43.4 to 98.6) Mean change at 3 months [mean (sd) difference, 95% CI] Treatment: 0.48 (16.92) Control: 3.13 (14.02) Forced expiratory volume in 1 second (FEV1) At 3 months: Treatment: 41.5% (95% CI 8.2% to 74.8%) Control: 41.9% (95% CI 6.2% to 77.6%)
Tibaldi 2004	Behavioural disturbances	Sleeping disorders T= 5/56 (9%) C= 23/53 (43%) difference ‐34%, 95% CI ‐50% to ‐19% P<0.001 Agitation/aggressiveness T= 5 /56 (9%) c= 22/53 (41.5%) difference ‐33% 95% CI ‐48% to ‐17% P<0.001 Feeding disorders T= 5 /56 (9%) C= 21/53 (40%) difference ‐31% 95% CI ‐46% to ‐16% P<0.001
Wilson 1999	Barthel Index:At 3 months, median (IQR)Treatment: 16 (13‐19)Control: 16 (12‐20)[0, ‐1.1 to 2.1]Sickness Impact Profile:At 3 months, median (IQR)Treatment: 24 (20‐31)Control: 26 (20‐31)[‐2, ‐4.1 to 4.0]	Barthel Index ‐ no (%) not assessed: treatment 21 (28%), control 18 (28%)Sickness Impact Profile ‐ no (%) not assessed: treatment 31 (41%), control 30 (46%)

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 1 Functional ability.

1.1 Admission avoidance patients recovering from a stroke functional ability

Other data

No numeric data

1.2 Admission avoidance patients with a medical condition ‐ functional ability

Other data

No numeric data

2 Quality of life Show forest plot

Other data

No numeric data

Analysis 1.2


Study	Outcomes	Results	Notes
Admission avoidance quality of life
Corwin 2005	SF 36 Physical functioning Role physical Pain (high score=better health)	SF 36 Physical functioning Day 3 T=37 (29.1) C=41 (28.3) Mean difference ‐1.9 95% CI ‐10.7 to 6.9 Day 6 T=50.7 (33.7) C=50.9 (31.6) Mean difference ‐5.2 95%CI ‐13.7 to 3.2 Role physical Day 3 T=5.4 (18.8) C=5.5 (19.7) Mean difference ‐1.8 95% CI ‐13.1 to 9.4 Day 6 T=21.1 (36.9) C=18.4 (36.5) Mean difference 2.2 95% CI ‐10.7 to 15.1 Pain Day 3 T=57 (28.8) C=55.9 (25.4) Mean difference ‐2.5 95% CI ‐10.1 to 5.1 Day 6 T=69.8 (26.4) C=64.8 (25.6) Mean difference ‐3.8 95% CI ‐10.6 to 3.0	Differences calculated on absolute differences between day 0 & day 3, or day 0 & day 6. Numbers vary due to missing data
Richards 2005	Mean physical component score SF‐12, higher score=better health	At 2 weeks T=38.1 [n=24] C=40.2 [p=25] P=0.45 At 6 weeks T=42.2 [n=24] C=45.8 [n=25] P=0.18 Mean mental component score SF‐12 At 2 weeks T=48.3 [n=24] C=48.6 [n=25] P=0.91 At 6 weeks T=50.4 [n=24] C=51.0 [n=25] P=0.81
Wilson 1999	Sickness Impact Profile Euroqol	Median (IQR) at 2 weeks T=29 (22‐34) n=69 C=30 (20‐34) n=57 difference ‐1 (95% CI ‐4.0 to 3.0) p=0.82 At 3 months T=24 (20‐31) n=70 C=26 (20‐31) n=66 difference ‐2 (95% CI ‐4 to 4) p=0.73 Euroqol Median (IQR) at 2 weeks T=0.59 (0.15 to 0.78) n=76 C=0.56 (0.19 0.73) n=62 difference 0.03 (95% CI ‐0.11 to 0.11) p=0.95 At 3 months T=0.64 n=73 C=0.63 n=68 difference 0.01 (95% CI ‐0.12 to 0.09) p=0.94

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 2 Quality of life.

2.1 Admission avoidance quality of life

Other data

No numeric data

3 Cognitive function Show forest plot

Other data

No numeric data

Analysis 1.3


Study	Outcomes	Results	Notes
admission avoidance ‐ cognitive function/psychological well being
Caplan 1999	Mental status questionnaire score from admission to discharge (maximum score 10); Number with confusion	Mean (SEM) T=0.43 (0.12) C=0.27 (0.12) NS Number with confusion T=0/51 C=10/49
Ricauda 2004	Geriatric Depression Scale score (range 0‐30) higher scores indicate depression	At 6 months Median IQR T=10 (5‐15) C=17 (13‐20) P=<0.001 (Mann Whitney)
Wilson 1999	Philadelphia Geriatric Morale Scale:	At 3 months: median (IQR) Treatment: 37 (30‐42) Control: 37 (31‐43) [0, ‐4.1 to 4.1]

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 3 Cognitive function.

3.1 admission avoidance ‐ cognitive function/psychological well being

Other data

No numeric data

4 Patient satisfaction Show forest plot

Other data

No numeric data

Analysis 1.4


Study	Outcomes	Results	Notes
Caplan 1999	Patient satisfaction: satisfaction rated on a 4 point scale: 1=excellent, 2=good, 3=fair, 4=poor.	Mean score Treatment:1.1 Control: 2.0 P<0.0001	Response rates were 78% for the treatment group, and 40% for the control.
Corwin 2005	Overall satisfaction	Very satisfied or quite satisfied T=87/91 (96%) C=87/96 (96%) P=0.12 Satisfaction with location of care, very satisfied or quite satisfied T=85/91 (93%) C=59/88 (66%) P<0.0001 Preferable to provide this type of care: In the hospital T=5/91 (5%) C=27/88 (31%) P<0.0001 In the community T=78/91 (86%) C=31/88 (35%) No preference T=8/91 (9%) C=30/88 (34%)	Numbers for control group vary between 88 and 91 due to missing data
Richards 2005	Reporting very happy with care	T=24/24 (100%) C=14/24 (60%) P=0.001
Wilson 1999	Patient satisfaction, scale 0 to 18	At 2 weeks, or discharge, median (IQR) Treatment: 15 (13 to 16.5) Control: 12 (11 to 14) P<0.0002

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 4 Patient satisfaction.

5 Clinical outcomes Show forest plot

Other data

No numeric data

Analysis 1.5


Study	Outcomes	Results	Notes
clinical outcomes
Corwin 2005	No advancement of cellulitis (indelible line drawn around peripheral margin of the cellulitis and dated)	Mean (sd) days T=1.5 (0.11) C=1.49 (0.10) Mean difference 0.01 days 95% CI ‐0.3 to 0.28 Days of no advancement of cellulites (95% CI) HR 0.98 (0.73 to 1.32) p=0.90 Days on intravenous antibiotics HR 0.84 (0.63 to 1.12) p=0.23 Days to discharge HR 0.93 (0.70 to 1.23) p=0.60 Days on oral antibiotics 1.09 (0.82 to 1.45) p=0.56
Davies 2000
Use of antipsychotic drugs
Tibaldi 2004	Use of antipsychotic drugs	On admission T= 26/56 (46.4%) C= 18/56 (32%) On discharge T= 6/56 (11%) C = 13/53 (25%) difference 14%, 95% CI ‐28% to 0.3%

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 5 Clinical outcomes.

5.1 clinical outcomes

Other data

No numeric data

5.2 Use of antipsychotic drugs

Other data

No numeric data

6 Cost Show forest plot

Other data

No numeric data

Analysis 1.6


Study	Outcomes	Results	Notes
health service costs
Caplan 1999	Cost	Average cost per episode: Treatment: $1,764 (sd $1,253) (n=50) Control: $3,775 (sd $2,496) (n=47) Mean difference per episode $‐2011 95% CI ‐$2800 to ‐$1222 Cost per day: Treatment: $191 (sd $58) (n=50) Control: $484 (sd $67.23) (n=47) mean difference per day ‐$293, 95% CI ‐$318 to ‐$268	Cost data financial year 1995/1996
Kalra 2000	Resources and cost	Physiotherapy Mean PIU (1 PIU=30 minutes) t=64.2 [n=140] c= 60 [n=147] Occupational therapy Mean PIU (1 PIU=30 minutes) t=9.8 [n=140] c=7.3 [n=147] Speech and language therapy Mean PIU (1 PIU=30 minutes) t=261.3 [n=140] c=240.7 [n=147] Mean costs Immediate care mean £ (sd) T=3856 (5062) [n=140] C=5952 (5054) [n=147] Mean difference: ‐£2096, 95% CI ‐£3272 to ‐£920 12 month follow up mean £ (sd) t=2984 (5749) [n=140] c=3575 (5705) [n=147] Mean difference: ‐£591 95% CI ‐£1922 to £740 Total cost excluding informal care T=6840 (9353) [n=140] C=9527 (8664) [n=147] Mean difference: £‐2687, 95% CI £‐4781 to £‐593 Total cost including informal care based on minimum wage rate T= 10 296 (11,613) [n=140] C=12,512 (10,369) [n=147] Mean difference £‐2216, 95% CI £‐4771 to £339 Total cost including informal care based on home help rate T= 17 226 (21,442) [n=140] C=18 498 (18,785) [n=147] mean difference £‐1272, 95% CI £‐5950 to £3406
Nicholson 2001	Costs	Treatment Mean cost per episode $745; n=13 95% CI $595 to $895 Control Mean $2543; n=12 95% CI $1766 to $3321 Difference $1798 P<0.01 Hah costs 29% of the average hospital managed patient episode. Reported cost effectiveness ratio of 3:1 Hospital + HAH costs GP 10% of costs, Domiciliary allied health 21% of costs, community nursing 28% of costs = 59% of costs and hospital care 41% of costs. If hospital costs=$895 then HAH costs = $1287 (59% of costs) Total costs=$2182 per patient episode of care	Costs based on financial year 99/00; Used average DRG costs (Australian $), patient data for ED costs, and modeled costs for OPD clinic visits. HAH care costed individually, included direct and non direct costs. GP costs at $91.00 per hour.
Ricauda 2004	Mean total cost (EUR converted to US$ 1 Euro=$1.3)	T=$6 413.5 per patient C=$6 504.8 per patient Cost per patient per day T=$163 (20.5) C=$275.6 (27.7) P<0.001
Richards 2005	CostCosts based on DRGs for control and actual cost for intervention	Mean cost per patient NZ$ T=$1157.9 C=$1556.28
Wilson 1999	Cost	Cost of initial episode: Treatment mean: £2,568.9 (2,089.3 to 2,972.1) Control mean: £2,880.6 (2,316.1 to 3,547.8) difference ‐311.7, p>0.43 bootstrap difference using 1000 subsamples: ‐304.72 (‐1,112.4 to 447.9). Mean cost per day: Treatment: £204.6 (91.5 to 118.4) Control: £104.9 £ (181.1 to 228.22) Mean difference £99.71 p<0.001 Cost at 3 months: Treatment mean: £3,671.3 (3,140.5 to 4,231.3) Control mean: £3,876.9 (3,224.51 to 4,559.6) difference ‐205.7, p>0.65 Bootstrap difference using 1000 subsamples: ‐210.9 (‐1,025 to 635.5) COSTS EXCLUDING REFUSERS Cost of initial episode Mean (95% CI) Treatment: £2,594.4 (95% CI £2,170.36 to £3,143.5) Control: £3,659.20 (£3,140.46 to £4,231.28) Mean difference ‐£1,064.79, p<0.01. Bootstrap mean difference £1070.53, (95% CI‐£1843.2 to ‐£245.73) 95% CI derived using bootstrap method with 1000 subsamples Mean cost per day (95% CI) Treatment: £206.68 (£183.21 to £230.14) Control: £133.7 (£124.6 to £142.8) Mean difference £72.98, p<0.001 Mean cost at 3 months: Treatment: £3,697.5 (£3136.13 to £4330.66) Control: £4,761.3 (£4105.6 to £5476.6) Mean difference ‐£1,063.8, p<0.025 Bootstrap mean difference: £1,063.45 (95% CI ‐£2043.8 to ‐£162.7)	Cost data financial year 1995/1996 BNF for medicines 1995
informal care inputs
Kalra 2000	Informal care inputs	Received informal care: T=100/140 (71%) C=98/147 (67%) Total from co residents over 12 months (hours) T=899.18 (1760) [n=140] C=718 (6778) [n=147] Total hours per average week from co residents T=46.38 (48.15) [n=140] C=33.71 (44.35) [n=147] Total hours from nonresidents over 12 months T=79.7 (283) [n=140] C=127.44 (348) [n=147] Total average hours per week from non residents T=4.79 (16.51) [n=140] C=5.03 (11.54) [n=147] Total hours over 12 months: T=979 (1749) C=846 (1549)
use of other health services
Davies 2000	Referred for increased social support: Treatment: 24/100 (24%)Control: 3/50 (6%)Difference 18%, 95%CI 7.3% to 28.6%	While receiving hospital at home care, or on discharge from hospital	0

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 6 Cost.

6.1 health service costs

Other data

No numeric data

6.2 informal care inputs

Other data

No numeric data

6.3 use of other health services

Other data

No numeric data

7 Length of stay Show forest plot

Other data

No numeric data

Analysis 1.7


Study	Results	Outcomes	Notes
Trials reporting length of stay
Davies 2000	Hospital length of stay	Control group: median 5 days (IQR 4 to 7 days) Control group: mean 6.72 (sd 4.3) n=50
Richards 2005	Median number of days to discharge	T=4 days (range 1‐14) C=2 days (range 0‐10) P=0.004
Wilson 1999	Length of stay	Hospital or hospital at home LOS Treatment median: 8 days Control median: 14.5 days P=0.026 Total days of care (hospital plus hospital at home): Treatment (n=100) median: 9 days Control (n=71) median:16 days; p=0.031 Mean difference: T mean:12.8 days (17.39) n=100 C mean: 26.93 (26.17) n=71 Difference ‐14.3, 95% CI ‐20.18 to ‐7.08	Hospital length of stay, and total days of care (hospital plus hospital at home) ‐ Mean (sd) unless stated otherwise

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 7 Length of stay.

7.1 Trials reporting length of stay

Other data

No numeric data

8 Treatment inputs Show forest plot

Other data

No numeric data

Analysis 1.8


Study	Outcomes	Results	Notes
Corwin 2005	Days on oral antibiotics	HR 1.09 (0.82 to 1.45) p=0.56
Kalra 2000	Physiotherapy (number treated) T=148/153 (98%) C=151/152 (99%) Occupational therapy (number treated) T=151/153 (99%) C=151/152 (99%) Speech therapy (number treated) T=75/153 (49%) C=106/152 (70%)

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 8 Treatment inputs.

9 Carer outcomes Show forest plot

Other data

No numeric data

Analysis 1.9


Study	Outcomes	Results	Notes
Carer satisfaction
Caplan 1999	Carer satisfaction:	Mean score Treatment: 1.1 Control: 1.9 P<0.0001	Satisfaction rated on a 4 point scale: 1=excellent, 2=good, 3=fair, 4=poor

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 9 Carer outcomes.

9.1 Carer satisfaction

Other data

No numeric data

10 GPs views Show forest plot

Other data

No numeric data

Analysis 1.10


Study	Outcomes	Results	Notes
Caplan 1999	GP satisfaction:	Mean score Treatment: 1.7 Control: 1.8 Non significant	Satisfaction rated on a 4 point scale: 1=excellent, 2=good, 3=fair, 4=poor

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 10 GPs views.

11 Anxiety and depression Show forest plot

Other data

No numeric data

Analysis 1.11


Study	Outcomes	Results	Notes
Ricauda 2004	Geriatric Depression Scale score (range 0‐30) higher scores indicate depression	Geriatric Depression At 6 months Median IQR T=10 (5‐15) C=17 (13‐20) P=<0.001 (Mann Whitney)

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 11 Anxiety and depression.

12 Readmission for hospital at home group within 2 weeks of randomisation Show forest plot

Other data

No numeric data

Analysis 1.12


Study	Outcomes	Results	Notes
Kalra 2000	Readmission within 2 weeks of randomisation	T=51/149

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 12 Readmission for hospital at home group within 2 weeks of randomisation.

13 Re admission to hospital for patients with a medical condition at 3 months Show forest plot

3

416

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [1.02, 2.15]

Analysis 1.13

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 13 Re admission to hospital for patients with a medical condition at 3 months.

13.1 Readmission for patients with a medical condition using number of events from trial databases

3

416

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [1.02, 2.15]

14 Readmissions at 3 months using published data Show forest plot

5

690

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [0.97, 1.87]

Analysis 1.14

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 14 Readmissions at 3 months using published data.

14.1 Elderly medical patients readmission using published data (Caplan follow‐up at 28 days)

3

447

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.83, 1.67]

14.2 Patients with cellulitis or pneumonia ‐ published data

2

243

Risk Ratio (M‐H, Fixed, 95% CI)

3.22 [1.08, 9.63]

15 Mortality during treatment Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.43, 1.54]

Analysis 1.15

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 15 Mortality during treatment.

16 Mortality at 3 months elderly patients with a medical condition (using data from trialists) Show forest plot

5

833

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.56, 1.23]

Analysis 1.16

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 16 Mortality at 3 months elderly patients with a medical condition (using data from trialists).

17 Mortality at 3 months using published data Show forest plot

3

644

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.60, 1.21]

Analysis 1.17

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 17 Mortality at 3 months using published data.

18 Mortality at 6 months follow up (using data from trialists, apart from Caplan) Show forest plot

4

707

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.58, 0.99]

Analysis 1.18

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 18 Mortality at 6 months follow up (using data from trialists, apart from Caplan).

19 Mortality at 6 months using published data Show forest plot

2

413

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.58, 1.19]

Analysis 1.19

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 19 Mortality at 6 months using published data.

20 Mortality at 1 year follow up Show forest plot

1

293

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.39, 1.05]

Analysis 1.20

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 20 Mortality at 1 year follow up.

21 Total length of stay to include hospital transfers for the hospital at home group Show forest plot

1

171

Mean Difference (IV, Fixed, 95% CI)

‐14.13 [‐21.11, ‐7.15]

Analysis 1.21

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 21 Total length of stay to include hospital transfers for the hospital at home group.

22 Living in an institutional setting at follow up ‐ patients recovering from a stroke Show forest plot

2

413

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.37, 1.15]

Analysis 1.22

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 22 Living in an institutional setting at follow up ‐ patients recovering from a stroke.

22.1 Recovering from a stroke at 6 months follow up

2

413

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.37, 1.15]

23 Living in a nursing home at follow up ‐ patients with dementia Show forest plot

1

109

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.03, 0.46]

Analysis 1.23

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 23 Living in a nursing home at follow up ‐ patients with dementia.

Comparison 2. Individual patient data meta‐analysis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Readmission at 3 months Show forest plot	3		Readmission (Fixed, 95% CI)	1.48 [0.95, 2.30]
Open in figure viewer Analysis 2.1 Comparison 2 Individual patient data meta‐analysis, Outcome 1 Readmission at 3 months.
2 Readmission 3 months (excluding readmissions in the first 14 days) Show forest plot	3		Readmission (Fixed, 95% CI)	1.41 [0.87, 2.30]
Open in figure viewer Analysis 2.2 Comparison 2 Individual patient data meta‐analysis, Outcome 2 Readmission 3 months (excluding readmissions in the first 14 days).
3 Mortality 3 months Show forest plot	5		Mortality (Fixed, 95% CI)	0.82 [0.58, 1.17]
Open in figure viewer Analysis 2.3 Comparison 2 Individual patient data meta‐analysis, Outcome 3 Mortality 3 months.
4 Mortality 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.68 [0.49, 0.95]
Open in figure viewer Analysis 2.4 Comparison 2 Individual patient data meta‐analysis, Outcome 4 Mortality 6 months.

Comparison 3. Individual patient data meta‐analysis adjusted for age only

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Readmission 3 months Show forest plot	3		Readmission (Fixed, 95% CI)	1.49 [0.96, 2.32]
Open in figure viewer Analysis 3.1 Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 1 Readmission 3 months.
2 Readmission 3 months (without readmission in the first 14 days) Show forest plot	3		Readmission (Fixed, 95% CI)	1.42 [0.87, 2.30]
Open in figure viewer Analysis 3.2 Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 2 Readmission 3 months (without readmission in the first 14 days).
3 Mortality 3 months Show forest plot	5		mortality (Fixed, 95% CI)	0.77 [0.54, 1.09]
Open in figure viewer Analysis 3.3 Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 3 Mortality 3 months.
4 Mortality 6 months Show forest plot	3		mortality (Fixed, 95% CI)	0.62 [0.44, 0.86]
Open in figure viewer Analysis 3.4 Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 4 Mortality 6 months.

Comparison 4. Individual patient data meta‐analysis adjusted for age and sex

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Readmissions 3 months Show forest plot	3		Readmission (Fixed, 95% CI)	1.49 [0.96, 2.33]
Open in figure viewer Analysis 4.1 Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 1 Readmissions 3 months.
2 Readmission 3 months (without readmission in the first 14 days) Show forest plot	3		Readmission (Fixed, 95% CI)	1.42 [0.87, 2.30]
Open in figure viewer Analysis 4.2 Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 2 Readmission 3 months (without readmission in the first 14 days).
3 Mortality at 3 months Show forest plot	5		mortality (Fixed, 95% CI)	0.77 [0.54, 1.09]
Open in figure viewer Analysis 4.3 Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 3 Mortality at 3 months.
4 Mortality at 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.45, 0.87]
Open in figure viewer Analysis 4.4 Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 4 Mortality at 6 months.

Comparison 5. IPD sensitivity analysis in favour of hospital

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Excluding readmissions in the 1st 14 days Show forest plot	3		Readmission (Fixed, 95% CI)	1.60 [0.99, 2.59]
Open in figure viewer Analysis 5.1 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 1 Excluding readmissions in the 1st 14 days.
1.1 Readmission excluding readmissions in the 1st 14 days	3		Readmission (Fixed, 95% CI)	1.60 [0.99, 2.59]
2 All readmissions Show forest plot	3		Readmissions (Fixed, 95% CI)	1.72 [1.11, 2.67]
Open in figure viewer Analysis 5.2 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 2 All readmissions.
3 Excluding readmissions in the 1st 14 days adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.62 [1.00, 2.62]
Open in figure viewer Analysis 5.3 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 3 Excluding readmissions in the 1st 14 days adjusted for age.
4 All readmissions adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.77 [1.14, 2.75]
Open in figure viewer Analysis 5.4 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 4 All readmissions adjusted for age.
5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.62 [1.00, 2.63]
Open in figure viewer Analysis 5.5 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex.
6 All readmissions adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.77 [1.14, 2.76]
Open in figure viewer Analysis 5.6 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 6 All readmissions adjusted for age and sex.
7 Mortality at 3 months Show forest plot	5		Mortality (Fixed, 95% CI)	0.83 [0.59, 1.17]
Open in figure viewer Analysis 5.7 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 7 Mortality at 3 months.
8 Mortality at 3 months adjusted for age Show forest plot	5		Mortality (Fixed, 95% CI)	0.77 [0.54, 1.09]
Open in figure viewer Analysis 5.8 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 8 Mortality at 3 months adjusted for age.
9 Mortality at 3 months adjusted for age and sex Show forest plot	5		Mortality (Fixed, 95% CI)	0.78 [0.55, 1.10]
Open in figure viewer Analysis 5.9 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 9 Mortality at 3 months adjusted for age and sex.
10 Mortality at 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.69 [0.49, 0.96]
Open in figure viewer Analysis 5.10 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 10 Mortality at 6 months.
11 Mortality at 6 months adjusted for age Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.45, 0.87]
Open in figure viewer Analysis 5.11 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 11 Mortality at 6 months adjusted for age.
12 Mortality at 6 months adjusted for age and sex Show forest plot	3		Mortality (Fixed, 95% CI)	0.63 [0.45, 0.87]
Open in figure viewer Analysis 5.12 Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 12 Mortality at 6 months adjusted for age and sex.

Comparison 6. IPD Sensitivity analysis in favour of hospital at home

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Excluding readmissions in the 1st 14 days Show forest plot	3		Readmission (Fixed, 95% CI)	1.26 [0.78, 2.04]
Open in figure viewer Analysis 6.1 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 1 Excluding readmissions in the 1st 14 days.
1.1 Readmission excluding readmissions in the 1st 14 days	3		Readmission (Fixed, 95% CI)	1.26 [0.78, 2.04]
2 All readmissions Show forest plot	3		Readmissions (Fixed, 95% CI)	1.29 [0.83, 2.00]
Open in figure viewer Analysis 6.2 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 2 All readmissions.
3 Excluding readmissions in the 1st 14 days adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.25 [0.77, 2.02]
Open in figure viewer Analysis 6.3 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 3 Excluding readmissions in the 1st 14 days adjusted for age.
4 All readmissions adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.29 [0.83, 2.00]
Open in figure viewer Analysis 6.4 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 4 All readmissions adjusted for age.
5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.26 [0.78, 2.04]
Open in figure viewer Analysis 6.5 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex.
6 All readmissions adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.30 [0.83, 2.01]
Open in figure viewer Analysis 6.6 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 6 All readmissions adjusted for age and sex.
7 Mortality at 3 months Show forest plot	5		Mortality (Fixed, 95% CI)	0.82 [0.58, 1.16]
Open in figure viewer Analysis 6.7 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 7 Mortality at 3 months.
8 Mortality at 3 months adjusted for age Show forest plot	5		Mortality (Fixed, 95% CI)	0.76 [0.54, 1.08]
Open in figure viewer Analysis 6.8 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 8 Mortality at 3 months adjusted for age.
9 Mortality at 3 months adjusted for age and sex Show forest plot	5		Mortality (Fixed, 95% CI)	0.76 [0.54, 1.09]
Open in figure viewer Analysis 6.9 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 9 Mortality at 3 months adjusted for age and sex.
10 Mortality at 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.68 [0.49, 0.95]
Open in figure viewer Analysis 6.10 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 10 Mortality at 6 months.
11 Mortality at 6 months adjusted for age Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.44, 0.86]
Open in figure viewer Analysis 6.11 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 11 Mortality at 6 months adjusted for age.
12 Mortality at 6 months adjusted for age and sex Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.44, 0.86]
Open in figure viewer Analysis 6.12 Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 12 Mortality at 6 months adjusted for age and sex.


Study	Functional ability	Results	Notes
Admission avoidance patients recovering from a stroke functional ability
Kalra 2000	Modified Rankin scale 0‐3 (measure of dependence: 0=independent and 3=dependent). Number independent and require minor assistance for day to day activities. Barthel 0‐20 (higher score=greater independence)	Modified Rankin At 3 months T=107/145 (74%) C=111/151 (74%) RR 1.00 (0.86, 1.15) P=0.96 At 12 months T=102/144 (71%) C=99/149 (66%) RR 0.94 (0.81, 1.09) P=0.42 Barthel 15‐20 (number with favourable outcome) At 3 months T=106/145 (73%) C=106/151 (70%) RR 0.96 (0.83, 1.11) P=0.58 At 12 months T=102/144 (71%) C=102/149 (69%) RR 0.97 (0.85, 1.11) P=0.65
Ricauda 2004	Activities of daily living (number of functions lost, score 0 to 6). Functional impairment measure (level of independence, range 28 to 126 with high score =greater independence). Canadian Neurological Scale Score (higher score=improvement, range 0‐10) National Institute of Health Stroke Scale Score (low score =improvement; range 0‐36)	Activities of daily living (scale 0 to 6) At 6 months Median IQR T=4 (2‐5) C=4 (2‐6) P=0.57 (Mann Whitney) Functional impairment measure (range 28 to 126) At 6 months Median IQR T=106 (67.5‐121.5) C=96.5 (56.5‐116.5) P=0.26 (Mann Whitney) Canadian Neurological Scale Score (range 0‐10) At 6 months Median IQR T=10 (8.5‐10.0) C=9.5 (7.0‐10.0) P=0.39 (Mann Whitney National Institute of Health Stroke Scale Score (range 0‐36) At 6 months Median IQR T=8 (4‐26) C=8 (6‐24) P=0.37 (Mann Whitney)
Admission avoidance patients with a medical condition ‐ functional ability
Caplan 1999	Change in Barthel score from admission to discharge (high score=greater independence) Instrumental activities of daily living score from admission to discharge (higher score=greater independence)	Mean (SEM) T= 0.37 (0.27) C= ‐0.04 (0.27) NS Mean (SEM) T=0.65 (0.23) C=‐0.88 (0.26) P=0.037
Davies 2000	St Georges' respiratory questionnaire: high score indicates poorer health related quality of life Forced expiratory volume in one second (FEV1):	Baseline scores Treatment: 71.5 (43.4 to 99.6) Control: 71 (43.4 to 98.6) Mean change at 3 months [mean (sd) difference, 95% CI] Treatment: 0.48 (16.92) Control: 3.13 (14.02) Forced expiratory volume in 1 second (FEV1) At 3 months: Treatment: 41.5% (95% CI 8.2% to 74.8%) Control: 41.9% (95% CI 6.2% to 77.6%)
Tibaldi 2004	Behavioural disturbances	Sleeping disorders T= 5/56 (9%) C= 23/53 (43%) difference ‐34%, 95% CI ‐50% to ‐19% P<0.001 Agitation/aggressiveness T= 5 /56 (9%) c= 22/53 (41.5%) difference ‐33% 95% CI ‐48% to ‐17% P<0.001 Feeding disorders T= 5 /56 (9%) C= 21/53 (40%) difference ‐31% 95% CI ‐46% to ‐16% P<0.001
Wilson 1999	Barthel Index:At 3 months, median (IQR)Treatment: 16 (13‐19)Control: 16 (12‐20)[0, ‐1.1 to 2.1]Sickness Impact Profile:At 3 months, median (IQR)Treatment: 24 (20‐31)Control: 26 (20‐31)[‐2, ‐4.1 to 4.0]	Barthel Index ‐ no (%) not assessed: treatment 21 (28%), control 18 (28%)Sickness Impact Profile ‐ no (%) not assessed: treatment 31 (41%), control 30 (46%)

Analysis 1.1

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 1 Functional ability.


Study	Outcomes	Results	Notes
Admission avoidance quality of life
Corwin 2005	SF 36 Physical functioning Role physical Pain (high score=better health)	SF 36 Physical functioning Day 3 T=37 (29.1) C=41 (28.3) Mean difference ‐1.9 95% CI ‐10.7 to 6.9 Day 6 T=50.7 (33.7) C=50.9 (31.6) Mean difference ‐5.2 95%CI ‐13.7 to 3.2 Role physical Day 3 T=5.4 (18.8) C=5.5 (19.7) Mean difference ‐1.8 95% CI ‐13.1 to 9.4 Day 6 T=21.1 (36.9) C=18.4 (36.5) Mean difference 2.2 95% CI ‐10.7 to 15.1 Pain Day 3 T=57 (28.8) C=55.9 (25.4) Mean difference ‐2.5 95% CI ‐10.1 to 5.1 Day 6 T=69.8 (26.4) C=64.8 (25.6) Mean difference ‐3.8 95% CI ‐10.6 to 3.0	Differences calculated on absolute differences between day 0 & day 3, or day 0 & day 6. Numbers vary due to missing data
Richards 2005	Mean physical component score SF‐12, higher score=better health	At 2 weeks T=38.1 [n=24] C=40.2 [p=25] P=0.45 At 6 weeks T=42.2 [n=24] C=45.8 [n=25] P=0.18 Mean mental component score SF‐12 At 2 weeks T=48.3 [n=24] C=48.6 [n=25] P=0.91 At 6 weeks T=50.4 [n=24] C=51.0 [n=25] P=0.81
Wilson 1999	Sickness Impact Profile Euroqol	Median (IQR) at 2 weeks T=29 (22‐34) n=69 C=30 (20‐34) n=57 difference ‐1 (95% CI ‐4.0 to 3.0) p=0.82 At 3 months T=24 (20‐31) n=70 C=26 (20‐31) n=66 difference ‐2 (95% CI ‐4 to 4) p=0.73 Euroqol Median (IQR) at 2 weeks T=0.59 (0.15 to 0.78) n=76 C=0.56 (0.19 0.73) n=62 difference 0.03 (95% CI ‐0.11 to 0.11) p=0.95 At 3 months T=0.64 n=73 C=0.63 n=68 difference 0.01 (95% CI ‐0.12 to 0.09) p=0.94

Analysis 1.2

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 2 Quality of life.


Study	Outcomes	Results	Notes
admission avoidance ‐ cognitive function/psychological well being
Caplan 1999	Mental status questionnaire score from admission to discharge (maximum score 10); Number with confusion	Mean (SEM) T=0.43 (0.12) C=0.27 (0.12) NS Number with confusion T=0/51 C=10/49
Ricauda 2004	Geriatric Depression Scale score (range 0‐30) higher scores indicate depression	At 6 months Median IQR T=10 (5‐15) C=17 (13‐20) P=<0.001 (Mann Whitney)
Wilson 1999	Philadelphia Geriatric Morale Scale:	At 3 months: median (IQR) Treatment: 37 (30‐42) Control: 37 (31‐43) [0, ‐4.1 to 4.1]

Analysis 1.3

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 3 Cognitive function.


Study	Outcomes	Results	Notes
Caplan 1999	Patient satisfaction: satisfaction rated on a 4 point scale: 1=excellent, 2=good, 3=fair, 4=poor.	Mean score Treatment:1.1 Control: 2.0 P<0.0001	Response rates were 78% for the treatment group, and 40% for the control.
Corwin 2005	Overall satisfaction	Very satisfied or quite satisfied T=87/91 (96%) C=87/96 (96%) P=0.12 Satisfaction with location of care, very satisfied or quite satisfied T=85/91 (93%) C=59/88 (66%) P<0.0001 Preferable to provide this type of care: In the hospital T=5/91 (5%) C=27/88 (31%) P<0.0001 In the community T=78/91 (86%) C=31/88 (35%) No preference T=8/91 (9%) C=30/88 (34%)	Numbers for control group vary between 88 and 91 due to missing data
Richards 2005	Reporting very happy with care	T=24/24 (100%) C=14/24 (60%) P=0.001
Wilson 1999	Patient satisfaction, scale 0 to 18	At 2 weeks, or discharge, median (IQR) Treatment: 15 (13 to 16.5) Control: 12 (11 to 14) P<0.0002

Analysis 1.4

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 4 Patient satisfaction.


Study	Outcomes	Results	Notes
clinical outcomes
Corwin 2005	No advancement of cellulitis (indelible line drawn around peripheral margin of the cellulitis and dated)	Mean (sd) days T=1.5 (0.11) C=1.49 (0.10) Mean difference 0.01 days 95% CI ‐0.3 to 0.28 Days of no advancement of cellulites (95% CI) HR 0.98 (0.73 to 1.32) p=0.90 Days on intravenous antibiotics HR 0.84 (0.63 to 1.12) p=0.23 Days to discharge HR 0.93 (0.70 to 1.23) p=0.60 Days on oral antibiotics 1.09 (0.82 to 1.45) p=0.56
Davies 2000
Use of antipsychotic drugs
Tibaldi 2004	Use of antipsychotic drugs	On admission T= 26/56 (46.4%) C= 18/56 (32%) On discharge T= 6/56 (11%) C = 13/53 (25%) difference 14%, 95% CI ‐28% to 0.3%

Analysis 1.5

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 5 Clinical outcomes.


Study	Outcomes	Results	Notes
health service costs
Caplan 1999	Cost	Average cost per episode: Treatment: $1,764 (sd $1,253) (n=50) Control: $3,775 (sd $2,496) (n=47) Mean difference per episode $‐2011 95% CI ‐$2800 to ‐$1222 Cost per day: Treatment: $191 (sd $58) (n=50) Control: $484 (sd $67.23) (n=47) mean difference per day ‐$293, 95% CI ‐$318 to ‐$268	Cost data financial year 1995/1996
Kalra 2000	Resources and cost	Physiotherapy Mean PIU (1 PIU=30 minutes) t=64.2 [n=140] c= 60 [n=147] Occupational therapy Mean PIU (1 PIU=30 minutes) t=9.8 [n=140] c=7.3 [n=147] Speech and language therapy Mean PIU (1 PIU=30 minutes) t=261.3 [n=140] c=240.7 [n=147] Mean costs Immediate care mean £ (sd) T=3856 (5062) [n=140] C=5952 (5054) [n=147] Mean difference: ‐£2096, 95% CI ‐£3272 to ‐£920 12 month follow up mean £ (sd) t=2984 (5749) [n=140] c=3575 (5705) [n=147] Mean difference: ‐£591 95% CI ‐£1922 to £740 Total cost excluding informal care T=6840 (9353) [n=140] C=9527 (8664) [n=147] Mean difference: £‐2687, 95% CI £‐4781 to £‐593 Total cost including informal care based on minimum wage rate T= 10 296 (11,613) [n=140] C=12,512 (10,369) [n=147] Mean difference £‐2216, 95% CI £‐4771 to £339 Total cost including informal care based on home help rate T= 17 226 (21,442) [n=140] C=18 498 (18,785) [n=147] mean difference £‐1272, 95% CI £‐5950 to £3406
Nicholson 2001	Costs	Treatment Mean cost per episode $745; n=13 95% CI $595 to $895 Control Mean $2543; n=12 95% CI $1766 to $3321 Difference $1798 P<0.01 Hah costs 29% of the average hospital managed patient episode. Reported cost effectiveness ratio of 3:1 Hospital + HAH costs GP 10% of costs, Domiciliary allied health 21% of costs, community nursing 28% of costs = 59% of costs and hospital care 41% of costs. If hospital costs=$895 then HAH costs = $1287 (59% of costs) Total costs=$2182 per patient episode of care	Costs based on financial year 99/00; Used average DRG costs (Australian $), patient data for ED costs, and modeled costs for OPD clinic visits. HAH care costed individually, included direct and non direct costs. GP costs at $91.00 per hour.
Ricauda 2004	Mean total cost (EUR converted to US$ 1 Euro=$1.3)	T=$6 413.5 per patient C=$6 504.8 per patient Cost per patient per day T=$163 (20.5) C=$275.6 (27.7) P<0.001
Richards 2005	CostCosts based on DRGs for control and actual cost for intervention	Mean cost per patient NZ$ T=$1157.9 C=$1556.28
Wilson 1999	Cost	Cost of initial episode: Treatment mean: £2,568.9 (2,089.3 to 2,972.1) Control mean: £2,880.6 (2,316.1 to 3,547.8) difference ‐311.7, p>0.43 bootstrap difference using 1000 subsamples: ‐304.72 (‐1,112.4 to 447.9). Mean cost per day: Treatment: £204.6 (91.5 to 118.4) Control: £104.9 £ (181.1 to 228.22) Mean difference £99.71 p<0.001 Cost at 3 months: Treatment mean: £3,671.3 (3,140.5 to 4,231.3) Control mean: £3,876.9 (3,224.51 to 4,559.6) difference ‐205.7, p>0.65 Bootstrap difference using 1000 subsamples: ‐210.9 (‐1,025 to 635.5) COSTS EXCLUDING REFUSERS Cost of initial episode Mean (95% CI) Treatment: £2,594.4 (95% CI £2,170.36 to £3,143.5) Control: £3,659.20 (£3,140.46 to £4,231.28) Mean difference ‐£1,064.79, p<0.01. Bootstrap mean difference £1070.53, (95% CI‐£1843.2 to ‐£245.73) 95% CI derived using bootstrap method with 1000 subsamples Mean cost per day (95% CI) Treatment: £206.68 (£183.21 to £230.14) Control: £133.7 (£124.6 to £142.8) Mean difference £72.98, p<0.001 Mean cost at 3 months: Treatment: £3,697.5 (£3136.13 to £4330.66) Control: £4,761.3 (£4105.6 to £5476.6) Mean difference ‐£1,063.8, p<0.025 Bootstrap mean difference: £1,063.45 (95% CI ‐£2043.8 to ‐£162.7)	Cost data financial year 1995/1996 BNF for medicines 1995
informal care inputs
Kalra 2000	Informal care inputs	Received informal care: T=100/140 (71%) C=98/147 (67%) Total from co residents over 12 months (hours) T=899.18 (1760) [n=140] C=718 (6778) [n=147] Total hours per average week from co residents T=46.38 (48.15) [n=140] C=33.71 (44.35) [n=147] Total hours from nonresidents over 12 months T=79.7 (283) [n=140] C=127.44 (348) [n=147] Total average hours per week from non residents T=4.79 (16.51) [n=140] C=5.03 (11.54) [n=147] Total hours over 12 months: T=979 (1749) C=846 (1549)
use of other health services
Davies 2000	Referred for increased social support: Treatment: 24/100 (24%)Control: 3/50 (6%)Difference 18%, 95%CI 7.3% to 28.6%	While receiving hospital at home care, or on discharge from hospital	0

Analysis 1.6

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 6 Cost.


Study	Results	Outcomes	Notes
Trials reporting length of stay
Davies 2000	Hospital length of stay	Control group: median 5 days (IQR 4 to 7 days) Control group: mean 6.72 (sd 4.3) n=50
Richards 2005	Median number of days to discharge	T=4 days (range 1‐14) C=2 days (range 0‐10) P=0.004
Wilson 1999	Length of stay	Hospital or hospital at home LOS Treatment median: 8 days Control median: 14.5 days P=0.026 Total days of care (hospital plus hospital at home): Treatment (n=100) median: 9 days Control (n=71) median:16 days; p=0.031 Mean difference: T mean:12.8 days (17.39) n=100 C mean: 26.93 (26.17) n=71 Difference ‐14.3, 95% CI ‐20.18 to ‐7.08	Hospital length of stay, and total days of care (hospital plus hospital at home) ‐ Mean (sd) unless stated otherwise

Analysis 1.7

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 7 Length of stay.


Study	Outcomes	Results	Notes
Corwin 2005	Days on oral antibiotics	HR 1.09 (0.82 to 1.45) p=0.56
Kalra 2000	Physiotherapy (number treated) T=148/153 (98%) C=151/152 (99%) Occupational therapy (number treated) T=151/153 (99%) C=151/152 (99%) Speech therapy (number treated) T=75/153 (49%) C=106/152 (70%)

Analysis 1.8

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 8 Treatment inputs.


Study	Outcomes	Results	Notes
Carer satisfaction
Caplan 1999	Carer satisfaction:	Mean score Treatment: 1.1 Control: 1.9 P<0.0001	Satisfaction rated on a 4 point scale: 1=excellent, 2=good, 3=fair, 4=poor

Analysis 1.9

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 9 Carer outcomes.


Study	Outcomes	Results	Notes
Caplan 1999	GP satisfaction:	Mean score Treatment: 1.7 Control: 1.8 Non significant	Satisfaction rated on a 4 point scale: 1=excellent, 2=good, 3=fair, 4=poor

Analysis 1.10

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 10 GPs views.


Study	Outcomes	Results	Notes
Ricauda 2004	Geriatric Depression Scale score (range 0‐30) higher scores indicate depression	Geriatric Depression At 6 months Median IQR T=10 (5‐15) C=17 (13‐20) P=<0.001 (Mann Whitney)

Analysis 1.11

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 11 Anxiety and depression.


Study	Outcomes	Results	Notes
Kalra 2000	Readmission within 2 weeks of randomisation	T=51/149

Analysis 1.12

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 12 Readmission for hospital at home group within 2 weeks of randomisation.

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Analysis 1.13

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 13 Re admission to hospital for patients with a medical condition at 3 months.

Analysis 1.14

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 14 Readmissions at 3 months using published data.

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Analysis 1.15

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 15 Mortality during treatment.

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Analysis 1.16

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 16 Mortality at 3 months elderly patients with a medical condition (using data from trialists).

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Analysis 1.17

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 17 Mortality at 3 months using published data.

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Analysis 1.18

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 18 Mortality at 6 months follow up (using data from trialists, apart from Caplan).

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Analysis 1.19

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 19 Mortality at 6 months using published data.

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Analysis 1.20

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 20 Mortality at 1 year follow up.

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Analysis 1.21

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 21 Total length of stay to include hospital transfers for the hospital at home group.

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Analysis 1.22

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 22 Living in an institutional setting at follow up ‐ patients recovering from a stroke.

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Analysis 1.23

Comparison 1 Admission avoidance hospital at home versus inpatient care, Outcome 23 Living in a nursing home at follow up ‐ patients with dementia.

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Analysis 2.1

Comparison 2 Individual patient data meta‐analysis, Outcome 1 Readmission at 3 months.

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Analysis 2.2

Comparison 2 Individual patient data meta‐analysis, Outcome 2 Readmission 3 months (excluding readmissions in the first 14 days).

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Analysis 2.3

Comparison 2 Individual patient data meta‐analysis, Outcome 3 Mortality 3 months.

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Analysis 2.4

Comparison 2 Individual patient data meta‐analysis, Outcome 4 Mortality 6 months.

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Analysis 3.1

Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 1 Readmission 3 months.

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Analysis 3.2

Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 2 Readmission 3 months (without readmission in the first 14 days).

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Analysis 3.3

Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 3 Mortality 3 months.

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Analysis 3.4

Comparison 3 Individual patient data meta‐analysis adjusted for age only, Outcome 4 Mortality 6 months.

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Analysis 4.1

Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 1 Readmissions 3 months.

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Analysis 4.2

Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 2 Readmission 3 months (without readmission in the first 14 days).

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Analysis 4.3

Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 3 Mortality at 3 months.

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Analysis 4.4

Comparison 4 Individual patient data meta‐analysis adjusted for age and sex, Outcome 4 Mortality at 6 months.

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Analysis 5.1

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 1 Excluding readmissions in the 1st 14 days.

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Analysis 5.2

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 2 All readmissions.

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Analysis 5.3

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 3 Excluding readmissions in the 1st 14 days adjusted for age.

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Analysis 5.4

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 4 All readmissions adjusted for age.

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Analysis 5.5

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex.

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Analysis 5.6

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 6 All readmissions adjusted for age and sex.

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Analysis 5.7

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 7 Mortality at 3 months.

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Analysis 5.8

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 8 Mortality at 3 months adjusted for age.

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Analysis 5.9

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 9 Mortality at 3 months adjusted for age and sex.

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Analysis 5.10

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 10 Mortality at 6 months.

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Analysis 5.11

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 11 Mortality at 6 months adjusted for age.

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Analysis 5.12

Comparison 5 IPD sensitivity analysis in favour of hospital, Outcome 12 Mortality at 6 months adjusted for age and sex.

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Analysis 6.1

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 1 Excluding readmissions in the 1st 14 days.

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Analysis 6.2

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 2 All readmissions.

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Analysis 6.3

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 3 Excluding readmissions in the 1st 14 days adjusted for age.

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Analysis 6.4

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 4 All readmissions adjusted for age.

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Analysis 6.5

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex.

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Analysis 6.6

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 6 All readmissions adjusted for age and sex.

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Analysis 6.7

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 7 Mortality at 3 months.

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Analysis 6.8

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 8 Mortality at 3 months adjusted for age.

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Analysis 6.9

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 9 Mortality at 3 months adjusted for age and sex.

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Analysis 6.10

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 10 Mortality at 6 months.

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Analysis 6.11

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 11 Mortality at 6 months adjusted for age.

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Analysis 6.12

Comparison 6 IPD Sensitivity analysis in favour of hospital at home, Outcome 12 Mortality at 6 months adjusted for age and sex.

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Comparison 1. Admission avoidance hospital at home versus inpatient care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Functional ability Show forest plot			Other data	No numeric data

1.1 Admission avoidance patients recovering from a stroke functional ability			Other data	No numeric data
1.2 Admission avoidance patients with a medical condition ‐ functional ability			Other data	No numeric data
2 Quality of life Show forest plot			Other data	No numeric data

2.1 Admission avoidance quality of life			Other data	No numeric data
3 Cognitive function Show forest plot			Other data	No numeric data

3.1 admission avoidance ‐ cognitive function/psychological well being			Other data	No numeric data
4 Patient satisfaction Show forest plot			Other data	No numeric data

5 Clinical outcomes Show forest plot			Other data	No numeric data

5.1 clinical outcomes			Other data	No numeric data
5.2 Use of antipsychotic drugs			Other data	No numeric data
6 Cost Show forest plot			Other data	No numeric data

6.1 health service costs			Other data	No numeric data
6.2 informal care inputs			Other data	No numeric data
6.3 use of other health services			Other data	No numeric data
7 Length of stay Show forest plot			Other data	No numeric data

7.1 Trials reporting length of stay			Other data	No numeric data
8 Treatment inputs Show forest plot			Other data	No numeric data

9 Carer outcomes Show forest plot			Other data	No numeric data

9.1 Carer satisfaction			Other data	No numeric data
10 GPs views Show forest plot			Other data	No numeric data

11 Anxiety and depression Show forest plot			Other data	No numeric data

12 Readmission for hospital at home group within 2 weeks of randomisation Show forest plot			Other data	No numeric data

13 Re admission to hospital for patients with a medical condition at 3 months Show forest plot	3	416	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [1.02, 2.15]

13.1 Readmission for patients with a medical condition using number of events from trial databases	3	416	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [1.02, 2.15]
14 Readmissions at 3 months using published data Show forest plot	5	690	Risk Ratio (M‐H, Fixed, 95% CI)	1.35 [0.97, 1.87]

14.1 Elderly medical patients readmission using published data (Caplan follow‐up at 28 days)	3	447	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.83, 1.67]
14.2 Patients with cellulitis or pneumonia ‐ published data	2	243	Risk Ratio (M‐H, Fixed, 95% CI)	3.22 [1.08, 9.63]
15 Mortality during treatment Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.43, 1.54]

16 Mortality at 3 months elderly patients with a medical condition (using data from trialists) Show forest plot	5	833	Odds Ratio (M‐H, Fixed, 95% CI)	0.83 [0.56, 1.23]

17 Mortality at 3 months using published data Show forest plot	3	644	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.60, 1.21]

18 Mortality at 6 months follow up (using data from trialists, apart from Caplan) Show forest plot	4	707	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.58, 0.99]

19 Mortality at 6 months using published data Show forest plot	2	413	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.58, 1.19]

20 Mortality at 1 year follow up Show forest plot	1	293	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.39, 1.05]

21 Total length of stay to include hospital transfers for the hospital at home group Show forest plot	1	171	Mean Difference (IV, Fixed, 95% CI)	‐14.13 [‐21.11, ‐7.15]

22 Living in an institutional setting at follow up ‐ patients recovering from a stroke Show forest plot	2	413	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.37, 1.15]

22.1 Recovering from a stroke at 6 months follow up	2	413	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.37, 1.15]
23 Living in a nursing home at follow up ‐ patients with dementia Show forest plot	1	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.11 [0.03, 0.46]

Comparison 1. Admission avoidance hospital at home versus inpatient care

Comparison 2. Individual patient data meta‐analysis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Readmission at 3 months Show forest plot	3		Readmission (Fixed, 95% CI)	1.48 [0.95, 2.30]

2 Readmission 3 months (excluding readmissions in the first 14 days) Show forest plot	3		Readmission (Fixed, 95% CI)	1.41 [0.87, 2.30]

3 Mortality 3 months Show forest plot	5		Mortality (Fixed, 95% CI)	0.82 [0.58, 1.17]

4 Mortality 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.68 [0.49, 0.95]

Comparison 2. Individual patient data meta‐analysis

Comparison 3. Individual patient data meta‐analysis adjusted for age only

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Readmission 3 months Show forest plot	3		Readmission (Fixed, 95% CI)	1.49 [0.96, 2.32]

2 Readmission 3 months (without readmission in the first 14 days) Show forest plot	3		Readmission (Fixed, 95% CI)	1.42 [0.87, 2.30]

3 Mortality 3 months Show forest plot	5		mortality (Fixed, 95% CI)	0.77 [0.54, 1.09]

4 Mortality 6 months Show forest plot	3		mortality (Fixed, 95% CI)	0.62 [0.44, 0.86]

Comparison 3. Individual patient data meta‐analysis adjusted for age only

Comparison 4. Individual patient data meta‐analysis adjusted for age and sex

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Readmissions 3 months Show forest plot	3		Readmission (Fixed, 95% CI)	1.49 [0.96, 2.33]

2 Readmission 3 months (without readmission in the first 14 days) Show forest plot	3		Readmission (Fixed, 95% CI)	1.42 [0.87, 2.30]

3 Mortality at 3 months Show forest plot	5		mortality (Fixed, 95% CI)	0.77 [0.54, 1.09]

4 Mortality at 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.45, 0.87]

Comparison 4. Individual patient data meta‐analysis adjusted for age and sex

Comparison 5. IPD sensitivity analysis in favour of hospital

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Excluding readmissions in the 1st 14 days Show forest plot	3		Readmission (Fixed, 95% CI)	1.60 [0.99, 2.59]

1.1 Readmission excluding readmissions in the 1st 14 days	3		Readmission (Fixed, 95% CI)	1.60 [0.99, 2.59]
2 All readmissions Show forest plot	3		Readmissions (Fixed, 95% CI)	1.72 [1.11, 2.67]

3 Excluding readmissions in the 1st 14 days adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.62 [1.00, 2.62]

4 All readmissions adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.77 [1.14, 2.75]

5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.62 [1.00, 2.63]

6 All readmissions adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.77 [1.14, 2.76]

7 Mortality at 3 months Show forest plot	5		Mortality (Fixed, 95% CI)	0.83 [0.59, 1.17]

8 Mortality at 3 months adjusted for age Show forest plot	5		Mortality (Fixed, 95% CI)	0.77 [0.54, 1.09]

9 Mortality at 3 months adjusted for age and sex Show forest plot	5		Mortality (Fixed, 95% CI)	0.78 [0.55, 1.10]

10 Mortality at 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.69 [0.49, 0.96]

11 Mortality at 6 months adjusted for age Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.45, 0.87]

12 Mortality at 6 months adjusted for age and sex Show forest plot	3		Mortality (Fixed, 95% CI)	0.63 [0.45, 0.87]

Comparison 5. IPD sensitivity analysis in favour of hospital

Comparison 6. IPD Sensitivity analysis in favour of hospital at home

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Excluding readmissions in the 1st 14 days Show forest plot	3		Readmission (Fixed, 95% CI)	1.26 [0.78, 2.04]

1.1 Readmission excluding readmissions in the 1st 14 days	3		Readmission (Fixed, 95% CI)	1.26 [0.78, 2.04]
2 All readmissions Show forest plot	3		Readmissions (Fixed, 95% CI)	1.29 [0.83, 2.00]

3 Excluding readmissions in the 1st 14 days adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.25 [0.77, 2.02]

4 All readmissions adjusted for age Show forest plot	3		Readmissions (Fixed, 95% CI)	1.29 [0.83, 2.00]

5 Readmissions excluding readmissions in the 1st 14 days adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.26 [0.78, 2.04]

6 All readmissions adjusted for age and sex Show forest plot	3		Readmissions (Fixed, 95% CI)	1.30 [0.83, 2.01]

7 Mortality at 3 months Show forest plot	5		Mortality (Fixed, 95% CI)	0.82 [0.58, 1.16]

8 Mortality at 3 months adjusted for age Show forest plot	5		Mortality (Fixed, 95% CI)	0.76 [0.54, 1.08]

9 Mortality at 3 months adjusted for age and sex Show forest plot	5		Mortality (Fixed, 95% CI)	0.76 [0.54, 1.09]

10 Mortality at 6 months Show forest plot	3		Mortality (Fixed, 95% CI)	0.68 [0.49, 0.95]

11 Mortality at 6 months adjusted for age Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.44, 0.86]

12 Mortality at 6 months adjusted for age and sex Show forest plot	3		Mortality (Fixed, 95% CI)	0.62 [0.44, 0.86]

Comparison 6. IPD Sensitivity analysis in favour of hospital at home