Evaluations of technology-enabled innovations of virtual wards and hospital at home using the systematic review methodology
What did we do?
Technology-enabled inpatient-level care at home innovations, such as virtual wards and hospital at home, are being rapidly implemented in the UK and internationally. The purpose of this review was to describe the components of technology-enabled care delivery innovations and link their components to evidence of effectiveness to explore implications for practice and research.
We are also doing a full evaluation of virtual wards in Greater Manchester.
Why was it important?
There are existing systematic reviews of interventions described as ‘hospital at home’ or ‘virtual wards’, compared with hospital-based inpatient care, in a range of populations. However none of the existing reviews were dedicated to technology-enabled innovations. It was important to fill this evidence gap to aid the implementation of technology-enabled innovations.
How did we do it?
Following Cochrane Systematic Review Methodology, we searched multiple databases and additional resources for randomised and non-randomised studies that compared technology-enabled inpatient-level care at home with hospital-based inpatient care. We classified interventions into care model groups using three key components:
- clinical activities,
- workforce, and
- technology.
We then synthesised the evidence by these groups for important outcomes; these included:
- mortality,
- hospital readmissions, and
- cost effectiveness.
Findings
The analyses, which included 69 studies (38 randomised and 31 non-randomised) and described 63 interventions, found that:
- None of the technology-enabled care at home models explored put people at higher risk of readmission compared with hospital-based care.
- Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to use of technology-enabled at home models.
- It is unclear whether inpatient-level care at home using higher levels of technology provide additional benefits.
- The evidence is mixed for length of stay.
- Cost-effectiveness evidence is unavailable for high technology-enabled models, and there is only limited evidence suggesting that the low technology-enabled multidisciplinary care model delivered by hospital-based teams may be cost-effective for people with COPD exacerbations.
Who we worked with
Downloadable resources:
More information
Senior Programme Lead
Mike Spence
mike.spence@healthinnovationmanchester.com