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A meta-analysis of “hospital in the home”

In reply: Dickson argues for exclusion of randomised controlled trials (RCTs) if treatments have changed, but treatments are constantly changing so, following this rule, meta-analysis would be impossible. Similarly, diagnosis has changed — stroke was a clinical diagnosis, then computed tomography was required, and now magnetic resonance imaging is needed. Equipoise is not a requirement for inclusion in a meta-analysis.

Complaints about research being simplistic because it aggregates patients and groups demonstrates a misconception of research, which is designed to aggregate one factor while other factors differ — for example, study arms may have different mixtures of ages but similar average ages. The meta-analysis studied effects of two systems of care — hospital and hospital in the home (HITH) — not a particular diagnosis or treatment.1,2 Therefore it is legitimate to aggregate hospital patients and compare them with HITH patients.

Location and heterogeneity were mathematically defined, there was no heterogeneity for mortality data, and other outcomes were adjusted appropriately.

Results from the study…