Do 'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls

Abstract

Background: This retrospective study will assess the extent to which multidisciplinary case management in the form of virtual wards (VWs) leads to changes in the use of health care and social care by patients at high risk of future unplanned hospital admission. VWs use the staffing, systems and daily routines of a hospital ward to deliver coordinated care to patients in their own homes. Admission to a VW is offered to patients identified by a predictive risk model as being at high risk of unplanned hospital admission in the coming 12 months.

Study design and data collection methods: We will compare the health care and social care use of VW patients to that of matched controls. Controls will be drawn from (a) national, and (b) local, individual-level pseudonymous routine data. The costs of setting up and running a VW will be determined from the perspectives of both health and social care organizations using a combination of administrative data, interviews and diaries.

Methods of analysis: Using propensity score matching and prognostic matching, we will create matched comparator groups to estimate the effect size of virtual wards in reducing unplanned hospital admissions.

Conclusions: THIS STUDY WILL ALLOW US TO DETERMINE RELATIVE TO MATCHED COMPARATOR GROUPS: whether VWs reduce the use of emergency hospital care; the impact, if any, of VWs on the uptake of primary care, community health services and council-funded social care; and the potential costs and savings of VWs from the perspectives of the national health service (NHS) and local authorities.

Keywords: clinical protocols; delivery of health care; evaluation studies; integrated.