Table 3.
GRADE evidence profile for summary of findings from non-randomized comparative studies.
| Quality assessment |
No of patients |
Effect |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies (participants) | Study design | Risk of bias |
Inconsistency | Indirectness | Imprecision | Other considerations |
Integrated care model |
Non-integrated care model |
Relative (95% CI) |
Absolute (95% CI) |
Quality |
| Mortality | |||||||||||
| 1 (2950) | Non-randomized comparative study |
Not Serious* |
Not serious | Not serious | Not serious | None | 149/1979 (7.5%) |
86/971 (8.9%) | RR0.6 (0.5–0.8) |
35 fewer per 1000 (from 18 fewer to 44 fewer) |
 |
| Missed days of school or work | |||||||||||
| 3 (3032 without and 10 282 with integrated care) |
Non-randomized comparative study |
Serious† | Not serious | Not serious† | Serious† | None | 4742 | 2112 | – | MD 10.2 lower (not reported) |
 |
| Emergency room visits | |||||||||||
| 2 (662 without and 1950 with integrated care) |
Non-randomized comparative study |
Not serious* |
Not serious | Not serious‡ | Not serious | None | 557/1907 (29.2%) |
225/639 (35.2%) | RR0.6 (0.5–0.7) |
141 fewer per 1000 (from 106 fewer to 176 fewer) |
 |
| Length of in-patient stay | |||||||||||
| 1 (4742 without and with integrated care) |
Non-randomized comparative study |
Serious† | Not serious | Not serious† | Serious† | None | 4742 | 2112 | – | MD 7.6 fewer (not reported) |
 |
| Quality of life - not measured | |||||||||||
| Joint damage or disease (and other measures of functional status) | |||||||||||
| 2 (10 763) | Non-randomized comparative study |
Not serious§ |
Not serious | Serious§ | Not serious | None | Severe disease: frequent HTC users had less ROM limitation than infrequent users (unadjusted analysis). Moderate disease: infrequent HTC users has less ROM limitation than frequent users (adjusted analysis). Mild disease: infrequent HTC users has less ROM limitation than frequent users (adjusted analysis). |
 |
|||
| Educational attainment – not measured | |||||||||||
| Patient knowledge | |||||||||||
| 1 (104) | Non-randomized comparative study |
Not serious¶ |
Not serious | Serious¶ | Serious¶ | None | Significantly fewer people who did not attend HTC in past 12 months sought information |
 |
|||
| Patient adherence - not measured | |||||||||||
CI, confidence interval; RR, risk ratio; MD, mean difference; HTC, Hemophilia Treatment Center; ROM, range-of-motion.
Potential for bias related to definition of integrated care as an HTC user with at least one visit to the centre but not downgraded.
Overall, the results were not adjusted for confounding factors, and the 95% confidence intervals were not calculated. There is also some indirectness as the integrated care model in 1970s/1980s has changed.
Not downgraded, although the number of hospitalizations was used as a surrogate for number of emergency room visits.
Overall, downgraded once for unadjusted analysis depending on severity of disease and differences in definition of integrated care and non-integrated care by frequency of HTC use.
Overall, the results were not adjusted for confounding, integrated care was defined as attendance at an HTC in last 12 months, and there were few events.