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. 2024 Feb 22:13:e50146.
doi: 10.2196/50146.

A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study

Alla Melman #  1 , Min Jiat Teng #  1   2 , Danielle M Coombs  1 , Qiang Li  3 , Laurent Billot  3 , Thomas Lung  3   4 , Eileen Rogan  5 , Mona Marabani  5 , Owen Hutchings  2 , Chris G Maher  1 , Gustavo C Machado  1 ; The Back@Home Investigators
Collaborators, Affiliations

A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study

Alla Melman et al. JMIR Res Protoc. .

Erratum in

Abstract

Background: Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia.

Objective: The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model.

Methods: This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an "audit and feedback" process. The implementation of "Back@Home" will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes.

Results: As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024).

Conclusions: This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts.

International registered report identifier (irrid): PRR1-10.2196/50146.

Keywords: back; back pain; cost; eHealth; economic; home care; hospital stay; hospital-based home care; implementation; length of stay; mobile phone; model of care; musculoskeletal; musculoskeletal pain; pain; readmission; remote care; telehealth; telemedicine; virtual care; virtual hospital.

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Conflict of interest statement

Conflicts of Interest: MJT is a physiotherapist at RPA Virtual Hospital.

Figures

Figure 1
Figure 1
Virtual low back pain service workflows. ED: Emergency Department; LBP: low back pain.
Figure 2
Figure 2
Knowledge to action framework. ED: Emergency Department; LBP: low back pain.
See this image and copyright information in PMC

References

    1. Emergency department care. Australian Institute of Health and Welfare (AIHW) 2021. [2024-01-17]. https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-depar... .
    1. Healthcare utilisation: hospital average length of stay by diagnostic categories. Organisation for Economic Co-operation and Development. 2018. [2024-01-17]. https://stats.oecd.org/index.aspx?queryid=30165 .
    1. Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet series call to action to reduce low value care for low back pain: an update. Pain. 2020;161 Suppl 1(1):S57–S64. doi: 10.1097/j.pain.0000000000001869. https://europepmc.org/abstract/MED/33090740 00006396-202009001-00007 - DOI - PMC - PubMed
    1. Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, Croft P. Low back pain: a call for action. Lancet. 2018;391(10137):2384–2388. doi: 10.1016/S0140-6736(18)30488-4. https://core.ac.uk/reader/156891281?utm_source=linkout S0140-6736(18)30488-4 - DOI - PubMed
    1. Waterman BR, Belmont PJ, Schoenfeld AJ. Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J. 2012;12(1):63–70. doi: 10.1016/j.spinee.2011.09.002.S1529-9430(11)01162-4 - DOI - PubMed