A systematic review that explores the different elements of innovative virtual wards including hospital at home and their clinical and cost effectiveness has been published in a leading medical journal.

Virtual wards and hospital at home offer patients an inpatient-level care in their own home. This is the first review to describe the different components used in such care and to link those service components to evidence of effectiveness.

Increasing pressures on health services - exacerbated in recent years by the COVID-19 pandemic - has resulted in the rapid development and implementation of innovative ways of providing hospital-level care in patients’ homes, often supported by technology.

‘Inpatient-level care at home’ models are expected to become a more integral feature of  future health systems with the continuing development of technologies such as telehealth platforms, wearables, and predictive algorithms including artificial intelligence, meaning people don’t always need to be in hospital to be treated and monitored.

The new analyses, led by researchers funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), classified ‘inpatient-level care at home’ based on their components including how much technology was involved, which staff delivered the care, and the scope of their clinical activities.

The novel review included 69 studies that compared inpatient-level care at home with hospital-based inpatient care, looking at mortality, hospital readmissions, cost-effectiveness and length of stay.

The analyses, which has been published in BMC Medicine, found that compared with hospital-based inpatient care:

• None of the technology-enabled care at home models explored appear to put people at higher risk of readmission. 

• There appears to be no additional risk of mortality due to use of technology-enabled at home models, but evidence is limited. 

• It is unclear whether inpatient-level care at home using high levels of technology provide additional benefits. 

• The impact of inpatient-level care at home on length of stay is mixed so conclusions are difficult to make.

• Cost-effectiveness evidence is unavailable for high technology-enabled models, and there is only limited evidence for specific low technology-enabled model that is focused on people with COPD exacerbations.

The review findings provide insights for future evaluations to assist NHS organisations planning to roll out these types of innovative models of care.

The authors of the review say further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation.

Dr Chunhu Shi, Research Fellow at The University of Manchester and NIHR ARC-GM Evaluation Theme, said: “The idea of inpatient-level treatment for patients at home has been developing for many years. More recently, these models of care have evolved to incorporate more technologies. 

“We know a lot about the traditional care at home models but, in terms of technology-enabled services, the research is still limited. Our review set out to address some of the gaps in previous evidence evaluations with a view to supporting decisions on technology-based services going forward.

“We found that the evidence is mixed, but it does appear that none of the inpatient-level care at home models put people at higher risk of readmission compared with hospital-based care, and probably don’t put them at higher risk of death. We don’t know if adding new technology makes these services any better.

“There is a need for a strong research programme to answer outstanding questions about ‘inpatient level care at home’, and NHS organisations may have a role in building that evidence base through their own evaluations of local implementation.”

Read the full review at: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03312-3