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PAPERS: Anne Forster, John Young, and Peter Langhorne Systematic review of day hospital care for elderly people BMJ 1999; 318: 837-841 [Abstract] [Full text]

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Effects of interventions may not be reflected in outcome measure

R W Fowler   (3 June 1999)

Effects of interventions may not be reflected in outcome measure 3 June 1999
R W Fowler Send response to journal: Re: Effects of interventions may not be reflected in outcome measure	Dear Sir The systematic review reported by Forster et al. [1] unsurprisingly provides little scientific support for day hospital care. However, the day hospital currently has many functions and it would be unhelpful to judge day hospitals simply because they failed to achieve good results on a small range of measurable outcomes. Other crucial hospital departments, such as Accident & Emergency departments, that similarly provide a wide range of activities, could be judged in the same way and found wanting. Although in the past day hospitals were almost unique in providing rehabilitation for older people living at home, with the advent of community care this is increasingly provided in a range of alternative settings. Most surviving day hospitals have adapted and specialise in providing rapid (usually next or following day) outpatient assessment, investigation and treatment of ill or disabled older people. The main strength of the successful day hospital is its flexibility - people can attend as often and for long as necessary and any number and variety of interventions can take place (e.g. therapeutic or palliative procedures such as blood transfusion or ascitic tap can be provided on the same visit as physiotherapy and falls assessment). The day hospital approach to these severely disabled people may therefore be focused on diagnosis, symptom palliation and service provision rather than just attempting to improve functional status. The effects of these interventions may not be reflected in the type of outcome measures conventionally used in meta-analysis. Yours sincerely R W Fowler Consultant Physician/Geriatrician St George's Hospital Suttons Lane Hornchurch Essex RM12 6RS Reference 1 Forster A, Young J, Langhorne P. Systematic review of day hospital care for elderly people. BMJ 1999;318:837-841