RAPID EVIDENCE SCAN The effectiveness of Virtual Hospital models of care A Rapid Evidence Scan brokered by the Sax Institute for Sydney Local Health District. January 2020. This report was prepared by: Gabriel Moore, Anton Du Toit, Brydie Jameson, Angus Liu and Mark Harris. January 2020 © Sax Institute 2020 This work is copyright. It may be reproduced in whole or in part subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the copyright owners. Enquiries regarding this report may be directed to the: Manager Knowledge Exchange Program Sax Institute www.saxinstitute.org.au [email protected] Phone: +61 2 9188 9500 Suggested Citation: Moore G, Du Toit A, Jameson B, Liu A, Harris M. The effectiveness of ‘virtual hospital’ models of care: a Rapid Evidence Scan brokered by the Sax Institute (www.saxinstitute.org.au) for Sydney Local Health District, 2020. Disclaimer: This report was produced using a rapid review methodology in response to specific questions from the commissioning agency. It is not necessarily a comprehensive review of all literature relating to the topic area. It was current at the time of production (but not necessarily at the time of publication). It is reproduced for general information and third parties rely upon it at their own risk. THE EFFECTIVENESS OF VIRTUAL HOSPITAL MODELS JANUARY 2020 | SAX INSTITUTE 2 Acronyms and abbreviations AR Absolute risk CAD Coronary artery disease CHF Chronic heart failure COPD Chronic obstructive pulmonary disease CR Cardiac rehabilitation DBD Diastolic blood pressure HCAD Home care activity desk HF Heart failure HR Hazard ratio LHD Local Health District LMIC Low- and middle-income countries LOS Length of stay MA Meta-analysis PDA Personal digital assistant PEDro Physiotherapy Evidence Database NSW New South Wales QoL Quality of life RR Relative risk SBP Systolic blood pressure SLHD Sydney Local Health District SR Systematic review STS Structured telephone support TSC Telephone supported care THE EFFECTIVENESS OF VIRTUAL HOSPITAL MODELS JANUARY 2020 | SAX INSTITUTE 3 Contents Acronyms and abbreviations ................................................................................................................................................................ 3 Contents ........................................................................................................................................................................................................ 4 Executive summary.................................................................................................................................................................................... 5 Tele-healthcare ....................................................................................................................................................................................... 6 Tele-healthcare and remote telemonitoring ................................................................................................................................ 6 Studies comparing tele-modalities .................................................................................................................................................. 7 Studies conducted using only remote modalities ....................................................................................................................... 7 Introduction ................................................................................................................................................................................................. 9 Background to this review ................................................................................................................................................................. 9 Methods ..................................................................................................................................................................................................... 11 Peer reviewed literature search .................................................................................................................................................... 11 Findings....................................................................................................................................................................................................... 12 Evidence for specific conditions ................................................................................................................................................... 12 Evidence for the use of tele-modalities .................................................................................................................................... 13 Evidence about cost and cost-effectiveness ........................................................................................................................... 15 Workforce to deliver virtual hospital interventions .............................................................................................................. 15 Appendices ................................................................................................................................................................................................ 18 A. PRISMA diagram ..................................................................................................................................................................... 18 B. Table of included studies .................................................................................................................................................... 19 C. Summary of included reviews ........................................................................................................................................... 39 D. Box 1: Summary of the virtual wards model (Lewis 2006) ..................................................................................... 45 References ................................................................................................................................................................................................. 46 THE EFFECTIVENESS OF VIRTUAL HOSPITAL MODELS JANUARY 2020 | SAX INSTITUTE 4 Executive summary Background There is international recognition of the need to reduce hospitalisations, readmissions and length of stay which are common and costly.1-6 Virtual hospitals provide hospital-level care in the community with a view to relieving pressure on already overburdened health care systems and to achieving equivalent or better clinical and health system outcomes. The populations targeted by virtual hospital models are those whose conditions are most likely to increase demand on limited bed capacity and on the workforce. These include for example, patients who are frail, elderly and/or who have one or more chronic conditions, such as coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease (COPD) and mental health, among others. However, there is limited rigorous evaluation of the effectiveness of the virtual hospital models of care. Because they aim to provide the same level of care as would be provided in hospital settings, virtual hospital models of care will include some of the following activities: identifying patients who are at high risk of hospitalisation, readmission or longer stays; assessing their health-related risks and needs; transitioning to the virtual hospital following discharge; developing individualised care plans; engaging the patient and family on treatment and care at home; coordinating care and facilitating communication including out of hours; providing direct treatment and rehabilitation using integrated multidisciplinary approaches; ensuring care is accessible; monitoring patients’ progress and reviewing readiness for discharge based on reduced predictive risk. The workforce required to deliver virtual hospital care will vary according to the needs of local high-risk patients and the conditions addressed.5 At the local level, the population served by Sydney Local Health District is growing rapidly. The ageing population and increasing incidence of chronic conditions mean that demand for health care is increasing more than ever before. Despite recent capital investment in Concord and Royal Prince Alfred (RPA) Hospitals, capacity remains constrained. New models are needed that can deliver health care that is patient centred, effective and efficient and not reliant on infrastructure such as physical space or hospital beds. Sydney Local Health District has begun planning for a new model of care, the RPA Virtual Hospital, (rpavirtual), with a view to delivering more care in the home, keeping people healthy, avoiding unnecessary hospital visits and reducing length of stay. rpavirtual will provide in-home nursing care to over 1,000 patients at any one time and harness new technology to connect with patients and deliver care using video, telephone, SMS and through suitable applications. To inform this service model, Sydney LHD commissioned a Rapid Evidence Scan about the effectiveness of virtual hospital models. This review was guided by the following question: What is known about the effectiveness of virtual hospital models of care? Methods To answer the review question, rapid but systematic searches were conducted of the peer reviewed literature.