‘Virtual ward’ post-discharge model did not reduce hospital readmissions

Using a post-discharge “virtual ward” model of care did not reduce readmission rates or death among high-risk patients discharged from the hospital, according to data published in JAMA.

The virtual ward model, which used various systems from hospital wards to provide care for patients in the community, was implemented in a randomized controlled trial of patients discharged from four hospitals in Toronto. Patients deemed at high risk for readmission or death were assigned to the virtual ward (n=963) or usual care (n=960). The primary outcome was the composite of hospital readmission or death at 30 days; secondary endpoints included admission to a nursing home or ED, and hospital readmission or death at 30 days, 90 days, 6 months and 1 year.

The virtual ward model involved aftercare provided by a coordinator, part-time pharmacist, part-time nurse or nurse practitioner and a clergy member. The team met daily and discussed patients, attempted to follow-up with physicians and patients, and counseled the patient. The goal was to promote coordination between the team and the patient, their primary care physician and specialists, and to arrange for any necessary home care or other services.

Usual care included written aftercare instructions and other treatments such as prescriptions and referrals.

At 30 days, 21.2% of virtual ward patients reached the primary endpoint, compared with 24.6% of those in the usual care group (absolute difference: 3.4%; 95% CI, –0.3% to 7.2%). This difference remained small between groups at 90 days; the primary endpoint was reached in 38% of patients in the usual care group vs. 37.1% of those in the virtual ward (absolute difference 0.9%; 95% CI, –3.4% to 5.2%). Between-group differences for the primary and secondary endpoints were not significant at 6 months or 1 year.

The researchers said study limitations included the lack of PCPs available via telephone or email, and it was possible the intervention was not robust enough.

“Our study showed that the virtual ward model of care did not reduce the primary outcome of readmission or death, or either component individually, in a diverse group of high-risk patients being discharged from hospital,” the researchers concluded.

In an accompanying editorial, Peter A. Boling, MD, of Virginia Commonwealth University, wrote, “An important aspect of their report was that the authors identified real-world obstacles including incompatible electronic health records, clinician discontinuity, difficulties integrating with primary care, and lack of contact with patients in hospital. These observations may be useful in the development of future trials designed to improve care transitions and reduce readmissions.”

For more information:

Dhalla IA. JAMA. 2014;312:1305-1312.

Boling PA. JAMA. 2014;312:1303-1304.

Disclosure: The researchers report no relevant financial disclosures.