Review: Early discharge hospital at home
Comparison: 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions Outcome: 6 Functional status at 3 months - older people with a mix of conditions
Study or subgroup Hospital at home Inpatient care DifferenceMean Weight DifferenceMean N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI
Cunliffe 2004 149 16.07 (3.54) 149 14.81 (4.09) 35.5 % 1.26 [ 0.39, 2.13 ] Martin 1994 27 14.89 (4.44) 17 14.29 (3.87) 4.3 % 0.60 [ -1.89, 3.09 ] Richards 1998 129 17.09 (3.65) 58 17.55 (2.33) 35.4 % -0.46 [ -1.33, 0.41 ] Shepperd 1998 54 18.46 (2.3) 56 18.34 (3.2) 24.8 % 0.12 [ -0.92, 1.16 ] Total (95% CI) 359 280 100.0 % 0.34 [ -0.18, 0.86 ] Heterogeneity: Chi2= 7.78, df = 3 (P = 0.05); I2=61% Test for overall effect: Z = 1.29 (P = 0.20)
Test for subgroup differences: Not applicable
-4 -2 0 2 4 Early discharge In-hospital care
102 Early discharge hospital at home (Review)
Analysis 2.7. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 7 Patient-reported outcomes.
Patient-reported outcomes
Study Results Notes
Quality of life/self-reported health status: Older people with a mix of conditions
Cunliffe 2004 EQ-5D (-0.59 to 1) 3 months
Mean difference 0.07 (95% CI -0.01 to 0.14) 12 months
Mean difference 0.02 (95% CI -0.06 to 0.09)
Self-reported health status
5 levels (1: no problems; 5: extreme problems)
Harris 2005 Self-reported recovery
10 days T: 25/128 (19.5%); C: 27/129 (20.9%), P = 0.78 30 days T: 39/121 (32.2%); C: 30/124 (24.2%), P = 0.16 90 days T: 63/112 (56.3%); C: 53/116 (45.7%), P = 0.11 SF 36*
Physical component scale- Mean (SD) T: 34.8 (10.7); C: 34.4 (9.9)
Difference 0.4 (95% CI -2.20 to 3.00) Mental component scale -Mean (SD) T: 53.4 (10.5); C: 52.1 (12.0) Difference 1.3 (95% CI -1.55 to 4.15)
* Short form survey of self-reported health status 36 items, higher scores better health status T: N = 121, C: N = 120
Richards 1998 EQ-5D after adjustment for baseline differences 4 weeks
Mean difference 0.00 (95% CI -0.09 to 0.10) 3 months
Mean difference -0.04 (95% CI -0.13 to 0.06)
EQ-5D
Shepperd 1998 Dartmouth COOP charts
Physical fitness T: 0.06; C: 0.00 Mean difference: 0.06 (95% CI -0.32 to 0.43) Feelings T: 0.26; C: 0.00 Mean difference: 0.26 (95% CI -0.43 to 0.95) Daily activities T: 0.39; C: 0.38 Mean difference: 0.01 (95% CI -0.64 to 0.67)
Dartmouth COOP charts Each domain scored 1 - 5 (low score: better quality of life) Mean change at 3 months from baseline Mean difference, 95% CI
Patient-reported outcomes (Continued) Social activities T: -0.10; C: 0.32 Mean difference -0.42 (95% CI -1.15 to 0.29) Pain T: 0.39; C: 0.35 Mean difference: 0.04 (95% CI -0.78 to 0.86) Change in health T: 0.92; C: 0.19 Mean difference: -0.27 (95% CI -1.06 to 0.53) Overall health T: -0.03; C: 0.16 Mean difference: -0.19 (95% CI -0.63 to 0.26) Social support T: 0.13; C: -0.05 Mean difference: 0.18 (95% CI -0.30 to 0.67) Quality of life T: 0.16; C: 0.35
Mean difference: -0.19 (95% CI-0.70 to 0.32) Functional status
T: -1.71; C: 1.27
Mean difference: 0.44 (95% CI -2.09 to 1.21)
Tibaldi 2013 Similar scores for both groups at 1-month follow-up Minnesota Living With Heart Failure Questionnaire Scores 0 - 105; lower scores: better quality of life No data reported
Quality of life/self-reported health status: Older people with COPD
Ojoo 2002 Respiratory symptom - Mean (SD) T: 12.1 (17.3); C: 11.6 (12.8)
St George’s Respiratory Questionnaire
Shepperd 1998 Dartmouth COOP charts* Physical fitness T: 0.40; C: -0.45 Mean difference: 0.22 (95% CI 95% CI -0.81 to 1.25) Feelings T: -0.45; C: 0.18 Mean difference: -0.63 (95% CI -2.13 to 0.86) Daily activities T: 0.00; C: 1.09
* Dartmouth COOP charts
Scale 1 - 5 (low score: better quality of life) Mean change at 3 months from baseline Mean difference, 95% CI
Patients with COPD Feelings - follow-up data for: treatment n = 10
control n = 11
** Chronic Respiratory Disease Questionnaire (low score: low level of functioning)
Treatment n = 10
104 Early discharge hospital at home (Review)
Patient-reported outcomes (Continued) Mean difference: -1.09 (95% CI -2.27 to 0.08) Social activities T: -0.82; C: 0.18 Mean difference: -1.00 (95% CI -2.48 to 0.48) Pain T: 0.73; C: 0.67 Mean difference: 0.06 (95% CI -1.24 to 1.36) Change in health T: 0.36; C: 0.73 Mean difference: -0.37 (95% CI -2.02 to 1.29) Overall health T: -0.18; C: 0.09 Mean difference: -0.27 (95% CI -1.03 to 0.48) Social support T: 0.00; C: 0.18 Mean difference: -0.18 (95% CI -1.33 to 0.97) Quality of life T: 0.18; C: 0.54 Mean difference: -0.36 (95% CI -1.22 to 0.49) CRD questionnaire** Dyspnea, scale 5 - 35 T: 0.94; C: -3.85 Mean difference: 0.79 (95% CI -2.07 to 11.65) Fatigue, scale 4 - 28 T: -0.40; C: -4.78 Mean difference: 4.38 (95% CI -0.31 to 9.07) Emotion, scale 7 - 49 T: -0.80; C: -8.66 Mean difference: 7.86 (95% CI -2.16 to 17.89) Mastery, scale 4 - 28 T: 0.00; C: -1.44 Mean difference: 1.44 (95% CI -5.93 to 8.82) Control n = 9
Skwarska 2000 No data reported Chronic Respiratory Questionnaire
Utens 2012 CCQ- Mean (SD)
T: 2.70 (1.32); C: 2.41 (1.14)
Mean difference: 0.29 (95% CI−0.12 to 0.70)
EQ-5D- Mean change from baseline (SE) T: 0.008 (0.039); C: -0.036 (0.0047), P = 0.64
Clinical COPD Questionnaire
10 items, total score 0 - 6 (higher score: worse health- related quality of life)
Patient-reported outcomes (Continued) Cognitive functioning Caplan 2006 MMSE* 1 month - Mean (SD) T: 23.89 (6.42); C: 24.52 (5.97), P = 0.66 6 months - Mean (SD) T: 23.22 (6.9); C: 25.18 (5.01), P = 0.24 CAM**
OR for delirium in T during rehabilitation phase 0.17 95% CI 0.03 to 0.65
Days of delirium during acute phase mean (SD) T: 3 (1.4); C: 2 (2.5), P = 0.62
* Mini Mental State Examination (MMSE) 30-item questionnaire
Lower scores: more impairment
** Confusion assessment method for assessing delirium
Harris 2005 MMSE
10-day - Mean change from baseline (SD) T: 0.04 (3.01); C: -0.01 (2.87)
Difference -0.05 (95% CI -0.67 to 0.77) 30 days - Mean change from baseline (SD) T: 0.36 (2.89); C: 0.34 (2.77)
Difference -0.02 (95% CI -0.70 to 0.74) 90-day - Mean change from baseline (SD) T: 0.20 (3.55); C: 0.72 (3.03)
Difference -0.44 (95% CI-1.38 to 0.35)
At 10 days: T: N = 125; C: N = 129 At 30 days: T: N = 117; C: N = 121 At 90 days: T: N = 117; C: N = 109
Martin 1994 Cognitive status
6 weeks - Median T: 8; C: 8 12 weeks - Median T: 9; C: 8
MMSE
At discharge from hospital - Mean (SD) T: 21.7 (7.1); C: 21 (7.3)
Mean difference 0 (95% CI -1.2 to 2.1)
Abbreviated Mental Test score (0 - 10) Higher score: better outcome No P value given
Insufficient data to calculate CI
Rada 2008 Delirium
T: 2/29 (6.9%); C: 2/25 (8%), P = 0.88
Confusion assessment method for assessing delirium
Tibaldi 2013 Similar scores between groups at 1 month follow-up MMSE
No other data provided
Psychological well-being
106 Early discharge hospital at home (Review)
Patient-reported outcomes (Continued) Caplan 2006 GDS At 1 month T: 8.84 (6.07); C: 8.17 (5.73), P = 0.63 At 6 months T: 7.8 (5.6); C=7.14 (3.96), P = 0.62
Geriatric Depression Scale
Higher scores: more symptoms of depression
Cunliffe 2004 GHQ
3 months
Mean difference -2.4 (95% CI -4.1 to -0.7) 12 months
Mean difference -1.9 (95% CI -3.5 to -0.4)
General Health Questionnaire Higher scores: worse mental health
Donald 1995 Psychological well-being
6 months - Mean
T: 12.4 (N = 21); C: 12.1 (N = 25)
Philadelphia Geriatric Center Morale Score Higher score: better outcome
No P value given
Insufficient data to calculate CI Harris 2005 FIM - mental subscale
10-day - Mean change from baseline (SD) T: 0.67 (2.47); C: 1.16 (3.34)
Difference -0.49 (95% CI -1.19 to 0.22) 30 days - Mean change from baseline (SD) T: 0.53 (2.20); C: 0.74 (2.44)
Difference -0.21 (95% CI -0.79 to 0.36) 90 day - Mean change from baseline (SD) T: 0.46 (3.19); C: 0.90 (4.19)
Difference -0.41 (95% CI-1.34 to 0.52)
Functional Independence Measure - mental subscale At 10 days: T: N = 134; C: N = 134
At 30 days: T: N = 126; C: N = 125 At 90 days: T: N = 124; C: N = 123
Martin 1994 Psychological well-being: At 6 weeks - Median T: 10; C: 12 12 weeks - Median T: 13; C: 9.5
Philadelphia Geriatric Center Morale Score Higher score: better outcome
No P value given
Insufficient data to calculate CI
Shepperd 1998 Elderly medical patients
Psychological well-being Baseline- Mean SD T: 6.54 (2.28); C: 7.93 (2.67) 3 months- Mean SD T: 0.16 (2.66); C: 0.73 (2.24) Difference -0.88 (95% CI -2.1 to 0.33)
Chronic obstructive airways disease
Psychological well-being
Philadelphia Geriatric Center Morale Score Higher score: better outcome
Patient-reported outcomes (Continued) Baseline- Mean SD T: 7.61 (2.4); C: 7.7 (2.68) 3 months- Mean SD T: 0.4 (2.32); C: 1.00 (2.93) Difference -0.6 (95% CI -3.03 to 1.83)
Tibaldi 2013 Similar scores between groups at 1-month follow-up Zung Self-Rating Depression Scale
20 items, score 20 to 80 (higher scores: more depression symptoms)
No other data provided
Analysis 2.8. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a