Wilson 1999.
| Study characteristics | ||
| Methods | Parallel randomised trial Study conducted between November 1995 and May 1997. |
|
| Participants | Setting: UK Patients with a mix of conditions (majority elderly) referred by GP to Bed Bureau Number recruited: hospital at home: 102; inpatient: 97 6 patients refused hospital at home care and were admitted to hospital. |
|
| Interventions | Hospital at home (admission avoidance) Type of service: multidisciplinary team (nurses, therapy, generic health workers, cultural link worker) Referred by a GP, who maintains medical responsibility Maximum of 5 patients at a time Control group: inpatient hospital care |
|
| Outcomes | Mortality, readmission, functional status, quality of life, patient satisfaction | |
| Notes | Follow‐up: 3 days, 2 weeks, 3 months Funding: National R&D Programme, Primary‐Secondary Care Interface, NHS Executive, North Thames (UK) Conflicts of interest: none reported Ethical approval: local ethics committee This author contributed IPD for a previous update of this review (Shepperd 2016a). |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Block randomisation |
| Allocation concealment (selection bias) | Low risk | Consecutively numbered, sealed envelopes |
| Baseline outcome measurements (selection bias) | Low risk | Baseline outcome measurements done prior to intervention for functional status and quality of life; no relevant differences found |
| Baseline characteristics (selection bias) | Low risk | Baseline characteristics of the study and control groups are reported and are similar |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Outcome assessments by independent research staff, decision to admit made by hospital staff, not research team |
| Blinding of outcome assessment (detection bias) Subjective outcomes | Low risk | Low risk for health status (Sickness Impact Profile 68), cognitive function (Clifton Assessment Procedures for the Elderly), functional status (Barthel Index), and quality of life (EuroQol) |
| Blinding of outcome assessment (detection bias) Objective outcomes | Low risk | Low risk for mortality, readmission, resource use and cost |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Loss to follow‐up: hospital at home: 8/87; hospital: 5/80 |
| Selective reporting (reporting bias) | Low risk | All outcomes reported (received trial data set) |
A&E: accident & emergency department C: control COPD: chronic obstructive pulmonary disease ED: emergency department FEV1: forced expiratory volume in 1 second GHHS: geriatric home hospitalisation service GP: general practitioner HADS: Hospital Anxiety and Depression Scale IPD: individual patient data IQR: interquartile range IV: intravenous MMSE: Mini‐Mental State Examination NIHR: National Institute for Health and Care Research NYHA: New York Heart Association OPD: outpatient department SD: standard deviation SF‐12: 12‐Item Short Form Health Survey SF‐36: 36‐Item Short Form Health Survey SpO2: oxygen saturation T: treatment