After being discharged from the hospital, heart failure patients who received “virtual ward” transition care—consisting of at-home visits, telehealth appointments, and/or clinic visits—had better outcomes and lower healthcare costs than those who received typical post-discharge care, according to a new JAMA Network Open study.[1]
Benefits of ‘virtual wards’ for heart failure patients
The heart failure patients who received virtual ward care after discharge were 14% less likely to die, 35% less likely to visit the emergency department, and 16% less likely to be readmitted to the hospital than those who received standard post-discharge care.
In some cases, their care may place less of a financial burden on the health care system. Out of seven randomized controlled trials which compared the cost of care for virtual wards to the cost of standard care, three reported “significant cost savings” ranging from $5,000 to $10,000 per patient. The other four trials showed the virtual ward interventions to be cost-neutral.
“The cost-saving virtual ward interventions all enrolled heart failure cohorts and reported that reduced hospitalization and length of stay in the intervention group greatly offset the added expense of home visits and clinic visits,” wrote study authors Utkarsh Chauhan, BSc, and Finlay A. McAlister, MD, MSc, both of the University of Alberta in Canada.
Post-discharge outcomes for high-risk patients, COPD patients, and patients with mixed medical diagnoses
In addition to heart failure patients, the study’s authors also examined the impacts of virtual wards on outcomes for three additional, separate cohorts: chronic obstructive pulmonary disease patients, patients with mixed medical diagnoses and patients viewed as high-risk.
Some benefits held across all groups for those who received virtual ward transition care: fewer emergency department visits, shorter length of stay during readmissions, and lower health care costs.
However, unlike patients in the heart failure cohort, other groups did not experience significant declines in mortality nor in hospital readmissions. The results led the authors to recommend that virtual ward transitional care programs should be targeted toward patients deemed most likely to derive benefit.
“Just as a single approach is not sufficient for most interventions in health care; it is clear from our data that not all patients benefit from virtual ward transitional programs,” the authors concluded.
How virtual wards differ from ‘hospital-at-home’ care
The authors made sure to note that virtual wards are not equivalent to "hospital-at-home" care. While the latter delivers inpatient-type care in patients’ homes, virtual wards are strictly focused on short-term, post-discharge care that serves a transitory role.
The virtual ward model examined in the study was first developed in England in 2006, according to the study. It typically includes the key component of in-home patient assessment by skilled health care personnel, along with multidisciplinary, team-based case management through some combination of virtual (telehealth), in-home, or clinic visits.
Within those guidelines, individual programs may vary significantly, making it difficult for the study’s authors to draw conclusions about which aspects of the program are most beneficial.
“Virtual ward programs in our study were heterogeneous in definition and intensity, which limits our ability to make specific recommendations about which virtual ward elements are key for implementation,” the group wrote.