A Cochrane review [Abstract] 1 included 16 studies with a total of 3 689 subjects. The studies compared day hospitals with comprehensive care (5 trials), domiciliary care (7 trials) or no comprehensive care (4 trials). For the outcome of death, there was no strong evidence for or against day hospitals compared to other treatments overall (OR 1.05; 95% CI 0.85 to 1.28; p = 0.66; 16 studies, n=3533), or to comprehensive care (OR 1.26; 95% CI 0.87 to 1.82; p = 0.22; 5 studies, n=1287), domiciliary care (OR 0.97; 95% CI 0.61 to 1.55; p = 0.89; 7 studies, n=901), or no comprehensive care (OR 0.88; 95% CI 0.63 to 1.22; p = 0.43; 4 studies, n=1345 ).For the outcome of death or deterioration in activities of daily living (ADL), there was no strong evidence for day hospital attendance compared to other treatments (OR 1.07; 95% CI 0.76 to 1.49; p = 0.70; 7 studies, n=1268), or to comprehensive care (OR 1.18; 95% CI 0.63 to 2.18; p = 0.61; 1 study, n=174), domiciliary care (OR 1.41; 95% CI 0.82 to 2.42; p = 0.21; 4 studies, n=443) or no comprehensive care (OR 0.76; 95% CI 0.56 to 1.05; p = 0.09; 2 studies, n=651).For the outcome of death or poor outcome (institutional care, dependency, deterioration in physical function), there was no strong evidence for day hospitals compared to other treatments (OR 0.92; 95% CI 0.74 to 1.15; p = 0.49; 13 studies, n=2831), or compared to comprehensive care (OR 1.05; 95% CI 0.79 to 1.40; p = 0.74; 5 studies, n=1268) or domiciliary care (OR 1.08; 95% CI 0.67 to 1.74; p = 0.75; 5 studies, n=581). However, compared with no comprehensive care there was a difference in favour of day hospitals (OR 0.72; 95% CI 0.53 to 0.99; p = 0.04; 3 studies, n=982).For the outcome of death or institutional care, there was no strong evidence for day hospitals compared to other treatments overall (OR 0.85; 95% CI 0.63 to 1.14; p = 0.28; 13 studies, n=3030), or to comprehensive care (OR 1.00; 95% CI 0.69 to 1.44; p = 0.99), domiciliary care (OR 1.05; 95% CI 0.57 to1.92; p = 0. 88) or no comprehensive care (OR 0.63; 95% CI 0.40 to 1.00; p = 0.05).For the outcome of deterioration in ADL, there was no strong evidence that day hospital attendance had a different effect than other treatments overall (OR 1.11; 95% CI 0.68 to 1.80; p = 0.67; 7 studies, n=905) or compared with comprehensive care (OR 1.21; 0.58 to 2.52; p = 0.61), or domiciliary care (OR 1.59; 95% CI 0.87 to 2.90; p = 0.13). However, day hospital patients showed a reduced odds of deterioration compared with those receiving no comprehensive care (OR 0.61; 95% CI 0.38 to 0.97; p = 0.04) and significant subgroup differences (p = 0.04).For the outcome of requiring institutional care, there was no strong evidence for day hospitals compared to other treatments (OR 0.84; 95% CI 0.58 to 1.21; p = 0.35), or to comprehensive care (OR 0.91; 95% CI 0.70 to 1.19; p = 0.49), domiciliary care (OR 1.49; 95% CI 0.53 to 4.25; p = 0.45), or no comprehensive care (OR 0.58; 95% CI 0.28 to 1.20; p = 0.14).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, interventions and outcomes).
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