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.