Designing a Virtual Hospital-at-Home Intervention for Patients with Infectious Diseases: A Data-Driven Approach

Abstract

Background: Virtual hospital-at-home care might be an alternative to standard hospital care for patients with infectious diseases. In this study, we explore the potential for virtual hospital-at-home care and a potential design for this population.

Methods: This was a retrospective cohort study of internal medicine patients suspected of infectious diseases, admitted between 1 January and 31 December 2019. We collected information on delivered care during emergency department visits, the first 24 h, between 24 and 72 h, and after 72 h of admission. Care components that could be delivered at home were combined into care packages, and the potential number of eligible patients per package was described. The most feasible package was described in detail.

Results: 763 patients were included, mostly referred for general internal medicine (35%), and the most common diagnosis was lower respiratory tract infection (27%). The most frequently administered care components were laboratory tests, non-oral medication, and intercollegiate consultation. With a combination of telemonitoring, video consultation, non-oral medication administration, laboratory tests, oxygen therapy, and radiological diagnostics, 48% of patients were eligible for hospital-at-home care, with 35% already eligible directly after emergency department visits.

Conclusion: While the potential for virtual hospital-at-home care is high, it depends greatly on which care can be arranged.

Keywords: hospital-at-home care; infectious diseases; telemedicine.

Figure 1

Percentage of patients eligible (in green) for remote hospital care if all components were available at home, besides rapid response team consultation, intensive care admission, high care intervention, or oxygen therapy > 5 L/min. Number of patients in a bar is presented in the bar. ED: emergency department. LRTI: lower respiratory tract infection. UTI: urinary tract infection. GI: gastrointestinal infection.

Figure 2

Potential of remote hospital care with different care packages. ED: emergency department. bp: basic package. p1: package 1 (bp + laboratory tests + ADL assistance + physiotherapy). p2: package 2 (bp + laboratory tests + radiology tests + oxygen). p3: package 3 (p2 + IV medication). p4: package 4 (p3 + ADL + physiotherapy). p5: package 5 (p4 + urine catheter OR central venous catheter OR feeding tube).