Evidence map›Paper›PMID 28180236›Full record

Trial reportAge and ageing2017

The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.

Opinder Sahota, Ruth Pulikottil-Jacob, Fiona Marshall, Alan Montgomery, Wei Tan, Tracey Sach, Pip Logan, Denise Kendrick, Alison Watson, Maria Walker and 1 more

Abstract readComparative StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Age and ageing, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Exercise for acutely hospitalised older medical patients.The Cochrane database of systematic reviews · 2022
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  7. Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review.International journal of environmental research and public health · 2019
    Pooled it
  8. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Opinder SahotaNottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
Ruth Pulikottil-JacobUniversity of Warwick, CoventryCV4 7AL, UK.
Fiona MarshallUniversity of Nottingham Business School, Jubilee Campus, Nottingham NG8 1BB, UK.
Alan MontgomerySchool of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Wei TanSchool of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Tracey SachNorwich Medical School, University of East Anglia, NorwichNR4 7TJ, UK.
Pip LoganSchool of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Denise KendrickSchool of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Alison WatsonNottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
Maria WalkerNottingham CityCare Partnership CIC, Nottingham NG1 6GN, UK.
Justin WaringUniversity of Nottingham Business School, Jubilee Campus, Nottingham NG8 1BB, UK.

Funding

Department of Health 11/1023/10
6 · The paper itself

Abstract

Objective: To compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service. Design: Pragmatic randomised controlled trial with an integral health economic study. Settings: Large UK teaching hospital, with community follow-up. Subjects: Frail older people aged 70 years and older admitted to hospital as an acute medical emergency. Measurements: Primary outcome: hospital length of stay; secondary outcomes: readmission, day 91-super spell bed days, functional ability, co-morbidity and health-related quality of life; cost-effectiveness analysis. Results: A total of 250 participants were randomised. There was no significant difference in length of stay between the CIRACT and THB-Rehab service (median 8 versus 9 days; geometric mean 7.8 versus 8.7 days, mean ratio 0.90, 95% confidence interval (CI) 0.74–1.10). Of the participants who were discharged from hospital, 17% and 13% were readmitted within 28 days from the CIRACT and THB-Rehab services, respectively (risk difference 3.8%, 95% CI −5.8% to 13.4%). There were no other significant differences in any of the other secondary outcomes between the two groups. The mean costs (including NHS and personal social service) of the CIRACT and THB-Rehab service were £3,744 and £3,603, respectively (mean cost difference £144; 95% CI −1,645 to 1,934). Conclusion: The CIRACT service does not reduce major hospital length of stay nor reduce short-term readmission rates, compared to the standard THB-Rehab service; however, a modest (<2.3 days) effect cannot be excluded. Further studies are necessary powered with larger sample sizes and cluster randomisation. Trial registration: ISRCTN 94393315, 25th April 2013

Indexed as

Hospital CostsAgedAged, 80 and overAge FactorsAgingCommunity Health ServicesComorbidityCost-Benefit AnalysisCost SavingsEmergency Medical ServicesEnglandFemaleHospitals, TeachingHumansLength of StayMale

Identifiers

PMID28180236
PMCPMC5377906

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.