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%)

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

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]

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

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%

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

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

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%)

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

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

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)

Kalra 2000

Readmission within 2 weeks of randomisation

T=51/149