Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in the healthcare context, interventions and outcomes).
A Cochrane review [Abstract] 1 included 10 studies with a total of 16,377 subjects. All studies were conducted in high income countries. They compared community-based care with institutional care (care homes). The sample size ranged from 98 to 11,803 (median n = 204). One study was a randomised trial (n = 112). Most studies did not select (or exclude) participants for any specific disease state; one study only included stroke patients.It is uncertain whether long-term home care compared to nursing home care decreases mortality (2 studies, n = 314). Estimates ranged from a nearly three-fold increased risk of mortality in the homecare group (RR 2.89, 95% CI 1.57 to 5.32) to a 62% relative reduction (RR 0.38, 95% CI 0.17 to 0.61).It is uncertain whether the intervention has a beneficial effect on physical function (5 studies, n = 1295).It is uncertain whether long-term home care improves happiness compared to nursing home care (RR 1.97, 95% CI 1.27 to 3.04) or general satisfaction (2 studies, n = 114).The extent to which long-term home care was associated to more or fewer adverse health outcomes than nursing home care was not reported.It is uncertain whether long-term home care compared to nursing home care decreases the risk of hospital admission (n = 14,853). RR estimates ranged from 2.75 (95% CI 2.59 to 2.92), showing an increased risk for those receiving care at home, to 0.82 (95% CI 0.72 to 0.93), showing a slightly reduced risk for the same group.
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