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National Guideline Centre (UK). Emergency and acute medical care in over 16s: service delivery and organisation. London: National Institute for Health and Care Excellence (NICE); 2018 Mar. (NICE Guideline, No. 94.)
Emergency and acute medical care in over 16s: service delivery and organisation.
Show detailsTable 8Clinical evidence profile: Matron/nurse-led care versus usual care
| Quality assessment | No of patients | Effect | Quality | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | All interventions | Control | Relative (95% CI) | Absolute | ||
| All-cause mortality (follow-up 6 weeks - 2 years) | ||||||||||||
| 34 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | None |
629/3868 (16.3%) |
629/3512 (17.9%) | RR 0.88 (0.8 to 0.98) | 21 fewer per 1000 (from 4 fewer to 36 fewer) |
⨁⨁⨁◯ MODERATE | CRITICAL |
| Length of stay (days) (follow-up 6 weeks - 1 year; Better indicated by lower values) | ||||||||||||
| 12 | randomised trials | no serious risk of bias | serious3 | no serious indirectness | no serious imprecision | None | 1128 | 1167 | - | MD 0.51 lower (1.33 to 0.31 lower) |
⨁⨁⨁⨁ HIGH | CRITICAL |
| Quality of life (high score is good) - Barthel Index (follow-up 1 year; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | serious2 | None | 116 | 135 | - | MD 3.99 higher (0.97 to 7.01 higher) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Quality of life (high score is good) - QoL Myocardial Infarction Questionnaire (follow-up 100 days; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | None | 134 | 133 | - | MD 8.40 higher (0.08 lower to 16.88 higher) |
⨁⨁⨁◯ MODERATE | CRITICAL |
| Quality of life (high score is good) - SF-36 Physical component (follow-up 12-24 weeks; Better indicated by higher values) | ||||||||||||
| 2 | randomised trials | serious1 | serious3 | no serious indirectness | serious2 | None | 141 | 138 | - | MD 10.78 higher (3 lower to 24.56 higher) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Quality of life (high score is good) - SF-36 Mental component (follow-up 12-24 weeks; Better indicated by higher values) | ||||||||||||
| 2 | randomised trials | serious1 | serious3 | no serious indirectness | serious2 | None | 142 | 142 | - | MD 7.15 higher (0.88 lower to 15.17 higher) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Quality of life (high score is bad) (follow-up 60 days - 2 years; Better indicated by lower values) | ||||||||||||
| 9 | randomised trials | serious1 | serious3 | no serious indirectness | no serious imprecision | None | 735 | 799 | - | MD 3.09 lower (5.43 to 0.75 lower) |
⨁⨁◯◯ LOW | CRITICAL |
| Admission (>30 days; continuous data) (follow-up 3-12 months; Better indicated by lower values) | ||||||||||||
| 6 | randomised trials | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | None | 649 | 624 | - | MD 0.04 higher (0.06 lower to 0.14 higher) |
⨁⨁⨁⨁ HIGH | CRITICAL |
| Admission (>30 days; dichotomous data) (follow-up 6 weeks - 2 years) | ||||||||||||
| 28 | randomised trials | serious1 | serious3 | no serious indirectness | no serious imprecision | None |
1403/3145 (44.6%) |
1339/2877 (46.5%) | RR 0.90 (0.82 to 1) | 47 fewer per 1000 (from 84 fewer to 0 more) |
⨁⨁◯◯ LOW | CRITICAL |
| Re-admission (follow-up 30 days - 1 year) | ||||||||||||
| 2 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | serious2 | None |
62/220 (28.2%) |
70/220 (31.8%) | RR 0.89 (0.67 to 1.17) | 35 fewer per 1000 (from 105 fewer to 54 more) |
⨁⨁◯◯ LOW | CRITICAL |
| GP visits (continuous data) (follow-up 6-12 months; Better indicated by lower values) | ||||||||||||
| 2 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | None | 171 | 126 | - | MD 0 higher (1.05 lower to 1.04 higher) |
⨁⨁⨁◯ MODERATE | IMPORTANT |
| GP visits (dichotomous data) (follow-up 3-24 months) | ||||||||||||
| 5 | randomised trials | serious1 | serious3 | no serious indirectness | serious2 | None |
332/486 (68.3%) |
404/529 (76.4%) | RR 0.88 (0.75 to 1.03) | 92 fewer per 1000 (from 191 fewer to 23 more) |
⨁◯◯◯ VERY LOW | IMPORTANT |
| Emergency department admissions (continuous data) (follow-up 6-12 months; Better indicated by lower values) | ||||||||||||
| 4 | randomised trials | no serious risk of bias | serious3 | no serious indirectness | no serious imprecision | None | 453 | 420 | - | MD 0.05 lower (0.38 lower to 0.28 higher) |
⨁⨁⨁◯ MODERATE | IMPORTANT |
| Emergency department admissions (dichotomous data) (follow-up 4 weeks - 12 months) | ||||||||||||
| 8 | randomised trials | serious1 | serious3 | no serious indirectness | serious2 | None |
132/531 (24.9%) |
168/524 (32.1%) | RR 0.74 (0.51 to 1.06) | 83 fewer per 1000 (from 157 fewer to 19 more) |
⨁◯◯◯ VERY LOW | IMPORTANT |
| Patient satisfaction (high score is good) (follow-up 60 days - 10 months; Better indicated by higher values) | ||||||||||||
| 2 | randomised trials | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | None | 227 | 232 | - | MD 1.26 higher (0.24 to 2.27 higher) |
⨁⨁⨁⨁ HIGH | IMPORTANT |
| Patient satisfaction (high score is bad) (follow-up 30 days; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | serious2 | None | 166 | 166 | - | MD 0.2 lower (0.33 to 0.07 lower) |
⨁⨁◯◯ LOW | IMPORTANT |
| Patient dissatisfaction; dichotomous data (follow-up 6 months) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | serious2 | None |
115/223 (51.6%) |
119/247 (48.2%) | RR 1.07 (0.89 to 1.28) | 34 more per 1000 (from 53 fewer to 135 more) |
⨁◯◯◯ VERY LOW | CRITICAL |
- 1
Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.
- 2
Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.
- 3
Heterogeneity, I2=50%, p=0.04, unexplained by subgroup analysis.
- Table 8, Clinical evidence profile: Matron/nurse-led care versus usual care - Em...Table 8, Clinical evidence profile: Matron/nurse-led care versus usual care - Emergency and acute medical care in over 16s: service delivery and organisation
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