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Meta-Analysis
. 2011 Dec 7;2011(12):CD004026.
doi: 10.1002/14651858.CD004026.pub2.

Day hospital versus admission for acute psychiatric disorders

Max Marshall  1 , Ruth Crowther, William Hurt Sledge, John Rathbone, Karla Soares-Weiser
Affiliations
Meta-Analysis

Day hospital versus admission for acute psychiatric disorders

Max Marshall et al. Cochrane Database Syst Rev. .

Abstract

Background: Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals.

Objectives: To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders.

Search methods: We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies.

Selection criteria: Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder.

Data collection and analysis: Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format.

Main results: Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days/month CI 1.97 to 2.70). There is no difference between day hospital care and inpatient care for the being readmitted to in/day patient care after discharge (5 RCTs, n = 667, RR 0.91 CI 0.72 to 1.15). It is likely that there is no difference between day hospital care and inpatient care for being unemployed at the end of the study (1 RCT, n = 179, RR 0.88 CI 0.66 to 1.19), for quality of life (1 RCT, n = 1117, MD 0.01 CI -0.13 to 0.15) or for treatment satisfaction (1 RCT, n = 1117, MD 0.06 CI -0.18 to 0.30).

Authors' conclusions: Caring for people in acute day hospitals is as effective as inpatient care in treating acutely ill psychiatric patients. However, further data are still needed on the cost effectiveness of day hospitals.

PubMed Disclaimer

Conflict of interest statement

Francis Creed, William Sledge, Herman Kluiter and Durk Wiersma have carried out trials of acute day hospital treatment.

Figures

1
1
Study flow diagram ‐ 2010 update
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 1 Feasibility and engagement: lost to follow‐up (at end of study).
1.2
1.2. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 2 Extent of hospital care: 1a. duration of index admission.
1.4
1.4. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 4 Extent of hospital care: 2. duration of all hospital care (days/month).
1.5
1.5. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 5 Extent of hospital care: 3. duration of day patient care (adjusted days/month).
1.6
1.6. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 6 Extent of hospital care: 4. duration of stay in hospital (days/month).
1.7
1.7. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 7 Extent of hospital care: 5. readmitted to in/day patient care after discharge.
1.8
1.8. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 8 Mental state: average endpoint score (BPRS, high = poor).
1.9
1.9. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 9 Social functioning: average overall role score (GSDS‐II, high = poor).
1.10
1.10. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 10 Burden: average carers' score (SBAS, high = poor).
1.11
1.11. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 11 Death (all causes).
1.12
1.12. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 12 Unemployed (at end of study).
1.13
1.13. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 13 Satisfaction with care: 1. not satisfied with care received.
1.14
1.14. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 14 Satisfaction with care: 2. average overall score (CAT, low = poor).
1.17
1.17. Analysis
Comparison 1 Day patient verus inpatient care for Type 1 studies, Outcome 17 Quality of life: average overall role score (MANSA, low = poor).
2.1
2.1. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 1 Feasibility and engagement: lost to follow‐up (at 2 years).
2.2
2.2. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 2 Extent of hospital care: 1. duration of all hospital care (days/month, IPD ‐ "nights in" & "nights out").
2.3
2.3. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 3 Extent of hospital care: 2. readmitted to in/day patient care after discharge.
2.4
2.4. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 4 Mental state: average endpoint score (PSE 9, high = poor, IPD).
2.5
2.5. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 5 Social functioning: average overall role score (Groningen Scale, IPD).
2.6
2.6. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 6 Death (all causes).
2.7
2.7. Analysis
Comparison 2 Day patient versus inpatient care for Type 2 trials (all presenting for admission were randomised), Outcome 7 Unemployed (at end of study).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Creed‐UK‐1990 {published data only}
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Herz‐US‐1971 {published data only}
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Kallert‐EU‐2007 {published data only}
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Kris‐US‐1965 {published data only}
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Zwerling‐US‐1964 {published data only}
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References to studies excluded from this review

Austin‐Los Angeles {published data only}
    1. Austin NK, Liberman RP, King LW, DeRisi WJ. A comparative evaluation of two day hospitals. Goal attainment scaling of behaviour therapy vs. milieu therapy. Journal of Nervous and Mental Disease 1976;163:253‐62. - PubMed
Azim‐Alberta {published data only}
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Barkley‐Ontario {published data only}
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Basker‐Jerusalem {published data only}
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Bateman‐London {published data only}
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Beigel‐New York {published data only}
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Bertrand‐Belgium {published data only}
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Boath‐Stoke {published data only}
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Bowman‐Dublin {published data only}
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Bradshaw‐Minnesota {published data only}
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Brook‐Denver {published data only}
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Carey‐US {published data only}
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Case‐New York {published data only}
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Comstock‐Texas {published data only}
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Creed‐Blackburn {published data only}
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Creed‐Manchester {published data only}
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Dal Santo 2004 {published data only}
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Davidson 2006 {published data only}
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Dick‐Dundee {published data only}
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Drake‐New Hampshire {published data only}
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Ettlinger‐New York {published data only}
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Fink‐Toronto {published data only}
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Glick‐New York {published data only}
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Glick‐San Francisco {published data only}
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Gudeman‐Boston {published data only}
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Guidry‐New Orleans {published data only}
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Guillette‐Maryland {published data only}
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Guy‐Baltimore {published data only}
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Herz‐New York2 {published data only}
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Hirsch‐London {published data only}
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Hogg‐Glasgow {published data only}
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Inch‐Saskatchewan {published data only}
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Jarema‐Warsaw {published data only}
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Kandel‐US {published data only}
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Kecmanovic‐Sarajevo {published data only}
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Klyczek‐US {published data only}
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Konieczynska‐Warsaw {published data only}
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Kuldau‐California {published data only}
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Levenson‐Houston {published data only}
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Liang‐Taipei {published data only}
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Linn‐USA {published data only}
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Lystad‐Louisiana {published data only}
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Mathai‐Bangalore {published data only}
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McDonnell‐Ireland {published data only}
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Meltzoff‐New York {published data only}
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Michaux 1969 {published data only}
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Michaux‐Maryland {published data only}
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Milne‐Wakefield {published data only}
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Newton‐US {published data only}
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Niskanen‐Helsinki {published data only}
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O'Shea‐Ireland {published data only}
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Odenheimer‐USA {published data only}
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Oka‐Kurume‐Japan {published data only}
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Pang‐US {published data only}
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Penk‐Dallas {published data only}
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Piersma‐Michigan {published data only}
    1. Piersma HL, Boes JL. Comparison of psychiatric day hospital patient and inpatient scores on the MCMI‐III. Journal of Clinical Psychology 1997;53(6):629‐34. - PubMed
Piper‐Alberta {published data only}
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Platt‐London {published data only}
    1. Platt SD, Knights AC, Hirsch SR. Caution and conservatism in the use of a psychiatric day hospital: evidence from a research project that failed. Psychiatry Research 1980;3:123‐32. - PubMed
Prior‐Middlesex {published data only}
    1. Prior S. Determining the effectiveness of a short‐term anxiety management course. British Journal of Occupational Therapy 1998;61(5):207‐13.
Russell‐Ottawa {published data only}
    1. Russell V, Mai F, Busby K, Attwood D, Davis M, Brown M. Acute day hospitalization as an alternative to inpatient treatment. Canadian Journal of Psychiatry 1996;41(10):629‐37. - PubMed
Sandell‐Stockholm {published data only}
    1. Sandell R, Alfredsson E, Berg M, Crafoord K. Clinical significance of outcome in long‐term follow‐up of borderline patients at a day hospital. Acta Psychiatrica Scandinavica 1993;87(6):405‐13. - PubMed
Shek 2009 {published data only}
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Skoda‐Czech Republic {published data only}
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Vaitl‐Haar‐Germany {published data only}
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Van Den Hout‐NL {published data only}
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Weldon‐New York {published data only}
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Wu 1995 {published data only}
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References to studies awaiting assessment

Vietze‐Germany {published data only}
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References to ongoing studies

Donnison 2001 {published data only}
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Gjonbalaj‐Marovic 2005 {published data only}
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References to other published versions of this review

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