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. 2024 Dec;36(6):929-937.
doi: 10.1111/1742-6723.14487. Epub 2024 Sep 13.

Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home)

Alla Melman  1   2 , Min J Teng  1   3 , Danielle M Coombs  1   4 , Qiang Li  5 , Laurent Billot  5 , Thomas Lung  2   5 , Eileen Rogan  6 , Mona Marabani  6 , Owen Hutchings  3 , Joshua R Zadro  1 , Chris G Maher  1   2 , Gustavo C Machado  1   2 ; Back@Home Investigators
Collaborators, Affiliations

Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home)

Alla Melman et al. Emerg Med Australas. 2024 Dec.

Abstract

Objectives: Low back pain was the sixth most common reason for an ED visit in 2022-2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes.

Methods: Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care.

Results: This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724-AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function.

Conclusions: Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.

Keywords: hospital‐based home care; low back pain; musculoskeletal pain; telemedicine.

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References

    1. AIHW [Australian Institute for Health and Welfare]. Emergency Department Care. Australian Institute of Health and Welfare; 2024. Available from URL: https://www.aihw.gov.au/reports‐data/myhospitals/sectors/emergency‐depar...
    1. Melman A, Maher CG, Needs C et al. Management of patients with low back pain admitted to hospital: an observational study of usual care. Int. J. Rheum. Dis. 2023; 26: 60–68.
    1. Coombs DM, Machado GC, Richards B et al. Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia. Lancet Reg. Health West Pac. 2021; 7: 100089.
    1. Melman A, Maher CG, Needs C, Machado GC. Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause. Clin. Rheumatol. 2022; 41: 1867–1871.
    1. Melman A, Teng MJ, Coombs DM et al. A virtual hospital model of care for low back pain, Back@Home: protocol for a hybrid effectiveness‐implementation type‐I study. JMIR Res. Protoc. 2024; 13: e50146.

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