C J Hyde1, I E Robert, A J Sinclair. 1. ARIF, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, UK.
Abstract
OBJECTIVE: to investigate the effects of supported discharge after an acute admission in older people with undifferentiated clinical problems. DESIGN: a systematic review of randomized controlled trials. METHODS: we searched MEDLINE, CINAHL, the Cochrane Library, PsycLit and the Social Science Citation Index up to the end of 1997. This was augmented by hand-searching, follow-up of bibliographies and.direct enquiry of authors of included studies. Application of inclusion decisions, quality assessment and data abstraction were carried out independently by at least two of the reviewers. We tabulated the results of the included studies and used meta-analysis where appropriate to refine conclusions. RESULTS: we finally included nine studies in the review, assessment of which revealed that bias was present, dictating the need for caution in interpreting results. Despite this, there was relative certainty that the proportion of those at home 6-12 months after admission is greater with supported discharge (odds ratio 1.4, 95% confidence interval 1.1- 2.0). This was associated with a consistent pattern of reduction in admission to long-stay care over the same period, without apparent increases in mortality. There was uncertainty about the effect of supported discharge on hospitalization. There were no rigorous research data on functional status, patient and carer satisfaction, and, in consequence, uncertainty about the overall effectiveness of supported discharge. CONCLUSIONS: we believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value. However, important sources of uncertainty remain, suggesting the need for further research.
OBJECTIVE: to investigate the effects of supported discharge after an acute admission in older people with undifferentiated clinical problems. DESIGN: a systematic review of randomized controlled trials. METHODS: we searched MEDLINE, CINAHL, the Cochrane Library, PsycLit and the Social Science Citation Index up to the end of 1997. This was augmented by hand-searching, follow-up of bibliographies and.direct enquiry of authors of included studies. Application of inclusion decisions, quality assessment and data abstraction were carried out independently by at least two of the reviewers. We tabulated the results of the included studies and used meta-analysis where appropriate to refine conclusions. RESULTS: we finally included nine studies in the review, assessment of which revealed that bias was present, dictating the need for caution in interpreting results. Despite this, there was relative certainty that the proportion of those at home 6-12 months after admission is greater with supported discharge (odds ratio 1.4, 95% confidence interval 1.1- 2.0). This was associated with a consistent pattern of reduction in admission to long-stay care over the same period, without apparent increases in mortality. There was uncertainty about the effect of supported discharge on hospitalization. There were no rigorous research data on functional status, patient and carer satisfaction, and, in consequence, uncertainty about the overall effectiveness of supported discharge. CONCLUSIONS: we believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value. However, important sources of uncertainty remain, suggesting the need for further research.
Authors: Kirsten J E Asmus-Szepesi; Paul L de Vreede; Anna P Nieboer; Jeroen D H van Wijngaarden; Ton J E M Bakker; Ewout W Steyerberg; Johan P Mackenbach Journal: BMC Geriatr Date: 2011-08-03 Impact factor: 3.921
Authors: Eliza Ly Wong; Carrie Hk Yam; Annie Wl Cheung; Michael Cm Leung; Frank Wk Chan; Fiona Yy Wong; Eng-Kiong Yeoh Journal: BMC Health Serv Res Date: 2011-09-29 Impact factor: 2.655
Authors: Carrie H K Yam; Eliza L Y Wong; Annie W L Cheung; Frank W K Chan; Fiona Y Y Wong; Eng-kiong Yeoh Journal: BMC Health Serv Res Date: 2012-11-14 Impact factor: 2.655