Evidence map›Paper›PMID 29680821›Full record

Trial reportThorax2018

Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation.

Carlos Echevarria, Joanne Gray, Tom Hartley, John Steer, Jonathan Miller, A John Simpson, G John Gibson, Stephen C Bourke

Registry-linked trialAbstract readRandomized Controlled TrialEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Thorax, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04330378 (A Hospital-at-Home Pilot in Singapore), which is not on this map. Cited by 34 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 10 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.

NCT04330378 completednot on this mapstarted 2021, after this paper: background citation

A Hospital-at-Home Pilot in Singapore: A Prospective Quasi-Experimental Cohort Study

TypeobservationalSponsorNational University Health System, SingaporeRan2021 to 2023Enrolled378ConditionsHospital-at-homeArmsHospital-at-home, Usual in-hospital care
3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  6. Admission avoidance hospital at home.The Cochrane database of systematic reviews · 2024
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  12. Hospital at Home vs conventional hospitalization: good clinical outcomes with lower cost and nosocomial complications.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026
    Observational
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Carlos EchevarriaRespiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
Joanne GrayNursing, Midwifery and Health Department, Northumbria University, Newcastle Upon Tyne, UK.
Tom HartleyRespiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
John SteerRespiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
Jonathan MillerRespiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
A John SimpsonICM, Newcastle University, Newcastle Upon Tyne, UK.ORCID 0000-0003-4731-7294
G John GibsonICM, Newcastle University, Newcastle Upon Tyne, UK.
Stephen C BourkeRespiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.

Funding

Department of Health PB-PG-0213-30105
6 · The paper itself

Abstract

backgroundPrevious models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable.

methodsIn a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days.

resultsMean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI -2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1-7), UC=5 (IQR 2-12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH being cost-effective was 90%. There was one death within 90 days in each arm, readmission rates were similar and 90% of patients preferred HAH for subsequent ECOPD.

conclusionHAH selected by low-risk DECAF score was safe, clinically effective, cost-effective, and preferred by most patients. Compared with earlier models, selection is simpler and approximately twice as many patients are eligible. The introduction of DECAF was associated with a fall in UC length of stay without adverse outcome, supporting use of DECAF to direct early discharge. TRIAL REGISTRATION NUMBER: Registered prospectively ISRCTN29082260.

Indexed as

AgedCost-Benefit AnalysisFemaleHome Care ServicesHospital CostsHumansLength of StayMalePatient SatisfactionPatient SelectionPrognosisProspective StudiesPulmonary Disease, Chronic ObstructiveRisk Factorscopd exacerbations

Identifiers

PMID29680821
PMCPMC6204956

What OpenQuestion holds

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Registered trials

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.