Abstract
BackgroundUnplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. Virtual Wards (VW) are an emerging concept to improve outcomes in these patients.PurposeTo evaluate the effect of post-discharge VWs, as an alternative to usual community based care, on hospital readmissions and mortality among heart failure and non-heart failure populations.Data sourcesOvid MEDLINE, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, SCOPUS and CINAHL, from inception through to Jan 31, 2017; unpublished data, prior systematic reviews; reference lists.Study selectionRandomized trials of post-discharge VW versus community based, usual care that reported all-cause hospital readmission and mortality outcomes.Data extractionData were reviewed for inclusion and independently extracted by two reviewers. Risk of bias was assessed using the Cochrane Collaboration risk of bias tool.Data synthesisIn patients with heart failure, a post-discharge VW reduced risk of mortality (six trials, n = 1634; RR 0.59, 95% CI = 0.44–0.78). Heart failure related readmissions were reduced (RR 0.61, 95% CI = 0.49–0.76), although all-cause readmission was not. In contrast, a post-discharge VW did not reduce death or hospital readmissions for patients with undifferentiated high-risk chronic diseases (four trials, n = .3186).LimitationsHeterogeneity with respect to intervention and comparator, lacking consistent descriptions and utilization of standardized nomenclature for VW. Some trials had methodologic shortcomings and relatively small study populations.ConclusionsA post-discharge VW can provide added benefits to usual community based care to reduce all-cause mortality and heart failure-related hospital admissions among patients with heart failure. Further research is needed to evaluate the utility of VWs in other chronic disease settings.
Highlights
Unplanned hospital admissions are common and costly [1]
Further research is needed to evaluate the utility of Virtual Wards (VW) in other chronic disease settings
We identified 4 operational a priori criteria to distinguish a VW from less intensive telemonitoring and case management interventions: 1) The care provided is similar to that provided by an interdisciplinary hospital ward team, 2) Care is longitudinally coordinated by an interdisciplinary team comprising at least two health professionals (e.g. MD, Nurse); 3) Care may be delivered in the patient’s home, through telephone or at a local clinic; 4) Care can include telemonitoring and case managers; there must be clear and evident oversight and integration of patient care by the interdisciplinary team
Summary
Over one third of patients are readmitted within 90 days, contributing to the estimated 17.4 billion dollar annual cost to Medicare for readmissions [2]. These costs are high in other healthcare systems [3]. Upwards of 59% of hospital readmissions may be avoidable [7] This has led many to evaluate alternative strategies to improve the integration of healthcare for patients at high risk of future hospitalizations [8]. Unplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. To evaluate the effect of post-discharge VWs, as an alternative to usual community based care, on hospital readmissions and mortality among heart failure and non-heart failure populations.
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