Comparison of Mortality and Hospital Readmissions Among Patients Receiving Virtual Ward Transitional Care vs Usual Postdischarge Care

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Abstract
Up to one-fifth of patients discharged from the hospital are readmitted within 30 days and up to one-third are readmitted within 3 months.1 Although many approaches to reducing readmissions have been tested, the results have often been disappointing, and those that have achieved reduction have been beneficial only in certain contexts.2 The virtual ward (VW), a model first developed in England in 2006, uses a multidisciplinary case-management model to provide short-term transitional care to community-dwelling patients after hospital discharge to prevent unplanned readmissions.3 The VW differs from the hospital at home concept, which seeks to deliver inpatient type care in patient homes, by focusing on the period after hospital discharge as patients transition to community care. Virtual ward models include patient assessment within their home by skilled health care professionals, care coordination, and multidisciplinary team-based case management by combinations of telehealth, in-home, and/or clinic visits. Despite the theoretical appeal of the model, 2 systematic reviews identified that the evidence on the use of VWs is mixed and limited (most studies were small and reported context-specific initiatives), and benefits were only seen in studies of patients with heart failure (HF).4,5 However, most of the studies included in those 2 reviews (6 of 10 in one4 and 26 of 31 in the other5) evaluated telemonitoring programs (ongoing telephone or video follow-up with or without transmission of patient-recorded vital signs) without the key component of the 2006 VW model: patient assessment within their homes by skilled health care personnel. As telemonitoring has been shown to be efficacious for patients with HF in a number of randomized clinical trials (RCTs),6 whether VW transitional care models are beneficial after hospital discharge remains unknown.

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