| Alternatives compared to Hospital care | |||||
|---|---|---|---|---|---|
| Outcomes | No of Participants (studies) Follow up | Quality of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
| Risk with Hospital care | Risk difference with Alternatives (95% CI) | ||||
| Alternatives compared with Hospital at home led by primary care - early discharge | |||||
| Mortality - early discharge - Hospital at home led by primary care |
591 (5 studies) |
⊕⊕⊝⊝ LOWa due to imprecision | RR 0.9 (0.47 to 1.71) | Moderate | |
| 69 per 1000 | 7 fewer per 1000 (from 37 fewer to 49 more) | ||||
| Length of stay (initial inpatient days) - early discharge - Hospital at home led by primary care |
222 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
The mean length of stay (initial inpatient days) - early discharge - hospital at home led by primary care in the intervention groups was 2.44 lower (3.34 to 1.54 lower) | ||
| Admissions - early discharge - Hospital at home led by primary care |
585 (6 studies) |
⊕⊕⊝⊝ due to risk of bias, imprecision | RR 0.92 (0.73 to 1.15) | Moderate | |
| 367 per 1000 | 29 fewer per 1000 (from 99 fewer to 55 more) | ||||
| Presentations to ED - early discharge - Hospital at home led by primary care |
222 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision | RR 0.44 (0.22 to 0.86) | Moderate | |
| 208 per 1000 | 116 fewer per 1000 (from 29 fewer to 162 fewer) | ||||
| Quality of life (high score is good) - early discharge - hospital at home led by primary care (SGRQ; change score; reversed) |
282 (2 studies) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
The mean QOL (high score is good) - early discharge - hospital at home led by (SGRQ change score; reversed) in the intervention groups was 3.49 higher (0.38 lower to 7.36 higher) | ||
| Quality of life (higher values better QoL) - early discharge - hospital at home led by primary care (COOP chart; change score; reversed) |
75 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
The mean Quality of life (higher values better QOL) - early discharge - hospital at home led by primary care (COOP chart; change score; reversed) in the intervention groups was 0.17 standard deviations higher (0.29 lower to 0.62 higher) | ||
| Patient Satisfaction (continuous-higher values more satisfied) - early discharge - Hospital at home led by primary care |
285 (2 studies) |
⊕⊕⊕⊕ HIGH | The mean patient satisfaction (continuous-higher values more satisfied) - early discharge - hospital at home led by primary care in the intervention groups was 0.25 standard deviations higher (0.01 to 0.48 higher) | ||
| Patient satisfaction (dichotomous) - early discharge - Hospital at home led by Primary care |
54 (1 study) |
⊕⊕⊕⊝ MODERATEb due to risk of bias | RR 1.04 (0.88 to 1.24) | Moderate | |
| 889 per 1000 | 36 more per 1000 (from 107 fewer to 213 more) | ||||
| Carer satisfaction (dichotomous) - early discharge - Hospital at home led by primary care |
34 (1 study) |
⊕⊕⊕⊝ MODERATEb due to risk of bias | RR 0.97 (0.79 to 1.19) | Moderate | |
| 929 per 1000 | 28 fewer per 1000 (from 195 fewer to 177 more) | ||||
| Quality of life (high score is good) - early discharge - hospital at home led by primary care (EQ-5D; change score) |
101 (1 study) |
⊕⊕⊝⊝ due to risk of bias, imprecision |
The mean Quality of life (high score is good) - early discharge - hospital at home led by primary care (eq-5d; change score) in the intervention groups was 0.04 higher (0.07 lower to 0.16 higher) | ||
| Alternatives compared with Hospital at home led by secondary care- early discharge | |||||
| Mortality - early discharge - Hospital at home led by secondary care |
31 (1study) |
⊕⊝⊝⊝ due to risk of bias, imprecision | RR 1.38 (0.22 to 8.59) | Moderate | |
| 111 per 1000 |
42 more per 1000 (from 87 fewer to 842 more) | ||||
| Readmissions-early discharge- Hospital at home led by secondary care |
84 (1 study) |
⊕⊝⊝⊝ due to risk of bias, imprecision, inconsistency, | RR 0.50 (0.05 to 5.31) | Moderate | |
| 127 per 1000 | 64 fewer per 1000 (from 121 fewer to 547 more) | ||||
| Alternatives compared with Hospital at home led by primary and secondary care - early discharge | |||||
| Mortality - early discharge - Hospital at home led by both primary and secondary care |
895 (4 studies) |
⊕⊝⊝⊝ due to risk of bias, imprecision | RR 1.02 (0.72 to 1.44) | Moderate | |
| 140 per 1000 | 3 more per 1000 (from 39 fewer to 62 more) | ||||
| Readmissions (30 days) - early discharge - Hospital at home led by both primary and secondary care |
285 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision | RR 1.66 (0.97 to 2.83) | Moderate | |
| 127 per 1000 | 84 more per 1000 (from 4 fewer to 232 more) | ||||
| Admissions - early discharge - Hospital at home led by both primary and secondary care |
835 (5 studies) |
⊕⊕⊕⊝ MODERATEb due to risk of bias | RR 0.94 (0.74 to 1.2) | Moderate | |
| 200 per 1000 | 12 fewer per 1000 (from 52 fewer to 40 more) | ||||
| Length of stay (days in treatment) - early discharge - Hospital at home led by primary and secondary care |
285 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
The mean length of stay (days in treatment) - early discharge - hospital at home led by primary and secondary care in the intervention groups was 3.1 higher (1.81 to 4.39 higher) | ||
| Carer satisfaction (dichotomous) - early discharge - Hospital at home led by both primary and secondary care |
127 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision | RR 1.61 (1.14 to 2.28) | Moderate | |
| 414 per 1000 | 253 more per 1000 (from 58 more to 530 more) | ||||
| Patient Satisfaction (continuous-higher values more satisfied) - early discharge - Hospital at home led by primary and secondary care |
281 (1 study) |
⊕⊕⊕⊝ MODERATEb due to risk of bias |
The mean patient satisfaction (continuous-higher values more satisfied) - early discharge - hospital at home led by primary and secondary care in the intervention groups was 0.25 standard deviations higher (0.01 to 0.48 higher) | ||
| Quality of life (high score is good) - early discharge - hospital at home led by primary and secondary care (final score; SF-36; physical) |
241 (1 study) |
⊕⊕⊕⊕ HIGH |
The mean Quality of life (high score is good) - early discharge - hospital at home led by primary and secondary care (final score; sf-36; physical) in the intervention groups was 0.4 higher (2.2 lower to 3 higher) | ||
| Patient satisfaction (dichotomous) - early discharge - Hospital at home led by both primary and secondary care |
232 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision | RR 1.15 (1 to 1.32) | Moderate | |
| 725 per 1000 | 109 more per 1000 (from 0 more to 232 more) | ||||
| Quality of life (high score is good) - early discharge - hospital at home led by primary and secondary care (final score; SF-36; mental) |
241 (1 study) |
⊕⊕⊕⊕ HIGH |
The mean Quality of life (high score is good) - early discharge - hospital at home led by primary and secondary care (final score; sf-36; mental) in the intervention groups was 1.3 higher (1.55 lower to 4.15 higher) | ||
| Alternatives compared with step-up/down care- early discharge | |||||
| Mortality - early discharge - Step up/down care |
1008 (3 studies) |
⊕⊕⊝⊝ due to risk of bias, imprecision | RR 0.88 (0.71 to 1.1) | Moderate | |
| 215 per 1000 | 26 fewer per 1000 (from 62 more to 22 more) | ||||
| Length of stay (initial inpatient days) - early discharge - Step up/down care |
518 (2 studies) |
⊕⊝⊝⊝ due to risk of bias, inconsistency, imprecision |
The mean length of stay (initial inpatient days) - early discharge - step up/down care in the intervention groups was 3.59 higher (1.23 to 5.95 higher) | ||
| Readmissions - early discharge - Step up/down care |
142 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision | RR 0.54 (0.31 to 0.96) | Moderate | |
| 357 per 1000 | 164 fewer per 1000 (from 14 fewer to 246 fewer) | ||||
| Alternatives compared with virtual wards- early discharge | |||||
| Mortality- early discharge- virtual wards |
57 (1 study) |
⊕⊝⊝⊝ due to risk of bias, imprecision | RR 0.72 (0.18 to 2.95) | Moderate | |
| 143 per 1000 | 40 fewer per 1000 (from 117 more to 279 more) | ||||
| Quality of life -early discharge- virtual wards (EQ-5D summary index; change score) |
57 (1 study) |
⊕⊕⊕⊝ MODERATEb due to risk of bias |
The mean Quality of life -early discharge- virtual wards (eq-5d summary index; change score) in the intervention groups was 0.00 higher (0.15 lower to 0.15 higher) | ||
| Alternatives compared with hospital at home led by primary care- admission avoidance | |||||
| Mortality - Admission avoidance - Hospital at home led by primary care |
285 (2 studies) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
RR 0.82 (0.53 to 1.29) | Moderate | |
| 309 per 1000 | 56 fewer per 1000 (from 145 fewer to 90 more) | ||||
| Admissions(>30 days) - Admission avoidance - Hospital at home led by primary care |
285 (2 studies) |
⊕⊕⊝⊝ LOWa due to imprecision | RR 1.29 (0.73 to 2.29) | Moderate | |
| 100 per 1000 | 30 more per 1000 (from 28 fewer to 133 more) | ||||
| Adverse events - Admission avoidance - Hospital at home led by primary care |
49 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision | RR 1.3 (0.62 to 2.73) | Moderate | |
| 320 per 1000 | 96 more per 1000 (from 122 fewer to 554 more) | ||||
| Days to discharge (hazard ratio) - Admission avoidance - Hospital at Home Primary Care (Hazard Ratio) |
194 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision | HR 0.95 (0.71 to 1.27) | Moderate | |
| 0 per 1000 | - | ||||
| Patient satisfaction (dichotomous) - Admission avoidance - Hospital at home led by Primary care |
179 (1 study) |
⊕⊕⊕⊕ HIGH | RR 0.97 (0.92 to 1.02) | Moderate | |
| 989 per 1000 | 30 fewer per 1000 (from 79 fewer to 20 more) | ||||
| Readmissions(<30 days) - Admission avoidance - Hospital at home led by primary care |
307 (2 studies) |
⊕⊕⊕⊕ HIGH | RR 4.68 (1.53 to 14.31) | Moderate | |
| 31per 1000 | 31per 1000 | ||||
| Quality of life (high score is good) - Admission avoidance - hospital at home led by primary care (final score; SF-12; mental) |
49 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision |
The mean Quality of life (high score is good) - admission avoidance - hospital at home led by primary care (final score; sf-12; mental) in the intervention groups was 0.6 lower (5.46 lower to 4.26 higher) | ||
| Quality of life (high score is good) - Admission avoidance - hospital at home led by primary care (final score; SF-12; physical) |
49 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
The mean Quality of life (high score is good) - admission avoidance - hospital at home led by primary care (final score; sf-12; physical) in the intervention groups was 3.6 lower (8.78 lower to 1.58 higher) | ||
| Alternatives compared with hospital at home led by secondary care- admission avoidance | |||||
| Mortality - Admission avoidance - Hospital at home led by secondary care |
329 (4 studies) |
⊕⊕⊝⊝ LOWa due to imprecision |
RR 0.8 (0.47 to 1.35) | Moderate | |
| 150 per 1000 |
30 fewer per 1000 (from 80 fewer to 53 more) | ||||
| Admissions(>30 days) - Admission avoidance - Hospital at home led by secondary care |
252 (3 studies) |
⊕⊕⊝⊝ due to risk of bias, imprecision | RR 0.56 (0.42 to 0.75) | Moderate | |
| 500 per 1000 | 220 fewer per 1000 (from 125 fewer to 290 fewer) | ||||
| Length of stay (days in treatment) - Admission avoidance - Hospital at home led by secondary care |
172 (2 studies) |
⊕⊕⊝⊝ due to risk of bias, inconsistency |
The mean length of stay (days in treatment) - admission avoidance - hospital at home led by secondary care in the intervention groups was 4.69 higher (2.86 to 6.52 higher) | ||
| Quality of life high score is good) - Admission avoidance - hospital at home led by secondary care (change score; SF-36; mental) |
71 (1 study) |
⊕⊕⊝⊝ due to risk of bias, imprecision |
The mean Quality of life (high score is good) - admission avoidance - hospital at home led by secondary care (change score; sf-36; mental) in the intervention groups was 1.2 higher (1.46 lower to 3.86 higher) | ||
| Patient satisfaction (dichotomous) - Admission avoidance - Hospital at home led by secondary care |
104 (1 study) |
⊕⊕⊕⊕ HIGH |
RR 1.07 (0.95 to 1.2) | Moderate | |
| 885 per 1000 | 62 more per 1000 (from 44 fewer to 177 more) | ||||
| Quality of life (high score is good) - Admission avoidance- hospital at home led by secondary care (NHP, change score; reversed) |
205 (2 studies) |
⊕⊕⊕⊝ MODERATEe due to inconsistency |
The mean Quality of life (high score is good) - admission avoidance - hospital at home led by secondary care (nhp, change score; reversed) in the intervention groups was 1.13 higher (0.29 to 1.97 higher) | ||
| Quality of life (high score is good) - Admission avoidance- hospital at home led by secondary care (change score; SF-36; physical) |
71 (1 study) |
⊕⊕⊝⊝ due to risk of bias, imprecision |
The mean Quality of life (high score is good) - admission avoidance - hospital at home led by secondary care (change score; sf-36; physical) in the intervention groups was 1.4 higher (2.38 lower to 5.18 higher) | ||
| Alternatives compared with hospital at home led by primary and secondary care- admission avoidance | |||||
| Adverse events - Admission avoidance - Hospital at home led by both primary and secondary care |
100 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision | RR 0.72 (0.27 to 1.93) | Moderate | |
| 163 per 1000 | 46 fewer per 1000 (from 119 fewer to 152 more) | ||||
| Admissions(>30 days) - Admission avoidance - Hospital at home led by both primary and secondary care |
250 (2 studies) |
⊕⊕⊝⊝ LOWa due to imprecision | RR 1.14 (0.74 to 1.74) | Moderate | |
| 221 per 1000 | 31 more per 1000 (from 57 fewer to 164 more) | ||||
| Mortality - Admission avoidance - Hospital at home led by both primary and secondary care |
150 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision | RR 1.12 (0.36 to 3.47) | Moderate | |
| 80 per 1000 | 10 more per 1000 (from 51 fewer to 198 more) | ||||
| Patient Satisfaction (continuous-higher score is good) - Admission avoidance - Hospital at home led by primary and secondary care (reversed scale) |
60 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision |
The mean patient satisfaction (continuous-higher score is good) - admission avoidance - hospital at home led by primary and secondary care (reversed scale) in the intervention groups was 1.98 standard deviations higher (1.33 to 2.64 higher) | ||
| Carer satisfaction (continuous) - Admission avoidance - Hospital at home led by primary and secondary care |
41 (1 study) |
⊕⊕⊕⊕ HIGH |
The mean carer satisfaction (continuous) - admission avoidance - hospital at home led by primary and secondary care in the intervention groups was 1.55 standard deviations higher (0.8 to 2.29 higher) | ||
| Quality of life (high score is good) - Admission avoidance - hospital at home led by primary and secondary care (SGRQ; change score; reversed) |
50 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision |
The mean Quality of life l (high score is good) - admission avoidance - hospital at home led by primary and secondary care (sgrq; change score; reversed) in the intervention groups was 2.83 lower (11.75 lower to 6.09 higher) | ||
| Alternatives compared with step-up/down care- admission avoidance | |||||
| Length of stay (initial inpatient days) - Admission avoidance - Step up/down care |
155 (1 study) |
⊕⊕⊝⊝ due to risk of bias, imprecision |
The mean length of stay (initial inpatient days) - admission avoidance - step up/down care in the intervention groups was 4.1 lower (8.58 lower to 0.38 higher) | ||
| Mortality - Admission avoidance - Step up/down care |
155 (1 study) |
⊕⊕⊕⊝ MODERATEa due to imprecision | RR 0.49 (0.22 to 1.09) | Moderate | |
| 208 per 1000 | 106 fewer per 1000 (from 162 fewer to 19 more) | ||||
| Alternatives compared with virtual wards- admission avoidance | |||||
| Mortality - Admission avoidance - Virtual wards |
1913 (1 study) |
⊕⊕⊝⊝ LOWa due to imprecision |
RR 0.85 (0.56 to 1.28) | Moderate | |
| 49 per 1000 | 7 fewer per 1000 (from 22 fewer to 14 more) | ||||
| Readmissions (30 days) - Admission avoidance - Virtual wards |
1919 (1 study) |
⊕⊕⊕⊕ HIGH | RR 0.89 (0.74 to 1.06) | Moderate | |
| 213 per 1000 | 23 fewer per 1000 (from 55 fewer to 13 more) | ||||
| Presentations to ED - Admission avoidance - Virtual wards |
1920 (1 study) |
⊕⊕⊕⊕ HIGH | RR 0.95 (0.82 to 1.09) | Moderate | |
| 296 per 1000 | 15 fewer per 1000 (from 53 fewer to 27 more) | ||||
Downgraded by 1 increment if the confidence interval crossed 1 MID point, and downgraded by 2 increments if the confidence interval crossed 2 MID points.
Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.
Downgraded by 1 or 2 increments because heterogeneity, I2=92%, unexplained by sub-group analysis.
Downgraded by 1 or 2 increments because heterogeneity, I2=88%, unexplained by sub-group analysis.
Downgraded by 1 or 2 increments because heterogeneity, I2=50%, unexplained by sub-group analysis.
From: Chapter 12, Alternatives to hospital care
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.