Young 2005.

Methods	Controlled clinical trial with historical controls recruited in two blocks (November 1998 ‐July 1999 and May ‐ November 1999) and intervention patients recruited in later blocks (January ‐ July 2001 and May ‐ October 2001). Collaborating partners Lead agency: Health authority. Strategic involvement (policy making and service planning): Health planners, primary health care and social services. Commissioning (implementing strategy taking account of resources available): Health planners, primary health care and social services. Operational (providing services directly): Primary health care and social services. Set in UK.
Participants	Patients living in three of five local Primary Care Trust areas around Leeds who had presented as emergency admissions to elderly care departments with falls, confusion, incontinence or immobility and who were still in hospital after 7 days were recruited by research nurses, aiming to recruit 50 per elderly care department per month. 848 intervention patients and 800 controls were recruited, of which 483 and 490 patients respectively were assessed for the primary outcome at 12 months. 333 patients in the intervention group (39%) and 301 in the control group (38%) had died by 12 months.  Male 33% (intervention group) and 30% (control group). Median age at baseline 85 (intervention group) and 83 (control group).
Interventions	Leeds Health Authority and Leeds City Council developed jointly a commissioning framework to provide support and rehabilitation to older patients following a health crisis at home or hospital admission, with care being given either at home or through short‐term care home placements. A joint care management team (multi‐agency, multidisciplinary) assessed need and purchased services from a Primary Care Trust based Intermediate Care team comprising nurses, therapists and social services staff. Control patients received usual care.
Outcomes	Primary outcome was independence at 6 months post recruitment measured by the Nottingham Extended Activities of Daily Living (NEADL) score six months after recruitment. Deaths and clinical outcomes, hospital and long‐term care use were also measured.
Notes	Power calculations suggested they required 600 analysable participants in each arm and they recruited 848 (intervention) and 800 (control) participants. Overall seems to be a reasonable evaluation study of a very poorly implemented service so little can be concluded about effectiveness. Only 29% intervention patients received the service and there was an apparent delay in service engagement as 44% of IC patients did not receive the service until more than 10 days after discharge.  The authors suggest that close integration with other older peoples services, a factor considered important to successful intermediate care, has not been adequately achieved. Appears to be reorganisation of existing resource rather than utilising additional resources. Overall risk of bias was high
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	No concealment
Blinding (performance bias and detection bias) All outcomes	High risk	Historical control group. Statistician was independent of study group.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete outcome data
Selective reporting (reporting bias)	Low risk	Range of outcomes reported and no reason to suspect selectivity.
Other bias	Unclear risk	Contemporaneous controls would have been better but groups appear to be well matched.
Randomisation adequately described/protected?	High risk	Not applicable
Protection against contamination?	Low risk	Potential threat is introduction of Primary Care Trusts (PCTs) during the study but no reason to assume major differences.
Follow‐up rate adequate?	Low risk	Excellent follow‐up of 97% in intervention and 96% in control group. Note: Uses historical controls pre‐dating the introduction of intermediate care.
Reliable primary outcome measure?	Low risk	Well used Nottingham Extended Activities of Daily Living score.
Groups measured at baseline?	Low risk	Groups approximately balanced. Historical controls and establishment of PCTs took place during recruitment process. Groups look well matched (Table 1) and no reason to assume major differences. The potential impact of seasonality was controlled for by recruitment at similar times of year.
Appropriate choice of controls (CBA studies only)?	High risk	Not applicable
Contemporaneous data collection (CBA studies only)?	Low risk	Not applicable
IS THE STUDY AT LOW RISK OF BIAS?	High risk	OVERALL RISK OF BIAS WAS HIGH