Virtual wards and hospital at home show no survival or readmission benefit for ECOPD patients compared to hospital admission.
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Key Takeaway
Note no survival or readmission benefit for VW/HaH in ECOPD exacerbations; more evidence needed for widespread adoption.
This systematic review and meta-analysis examined the safety and efficacy of virtual wards (VW) and hospital at home (HaH) care pathways compared to standard hospital admission for adults with exacerbations of chronic obstructive pulmonary disease (ECOPD). The analysis included data from 11 studies, with one assessing VWs and ten assessing HaH, conducted in hospital or patient home settings. The primary outcomes assessed were safety, specifically mortality rates at all causes, in-patient, 7 days, and 30 days, as well as readmission rates at 7 and 30 days. Secondary outcomes included length of stay in hospital and changes in pulmonary function tests.
Regarding primary outcomes, the meta-analysis found no changes in survival attributable to the interventions. Similarly, there were no changes in short-term readmission rates. Furthermore, there was no evidence that VW or HaH care pathways reduced the total time a patient spent under hospital-led care. Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported in the included studies.
The authors note that more evidence is needed to support the widespread roll-out of HaH and especially VW pathways for ECOPD. Consequently, clinicians should interpret these findings with caution, recognizing that current data does not demonstrate a reduction in hospital time or improvement in survival or readmission metrics for this specific population.
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View Original Abstract ↓
OBJECTIVES: Given increasing interest in admission avoidance, we evaluated the evidence to support virtual wards (VW) and hospital at home (HaH) models of care during exacerbations of chronic obstructive pulmonary disease (ECOPD).
DESIGN: A systematic review and meta-analysis. A comprehensive search of MEDLINE (1946 to March 2024), Embase (1974 to March 2024) and CENTRAL (searched 22 March 2024) was conducted. Risk of bias and a random effects meta-analysis were performed.
POPULATION: Adults with an ECOPD presenting to the hospital or who require hospital-led care.
INTERVENTIONS: VW: defined as assessments and interventions delivered remotely or HaH (defined as assessments and interventions delivered by healthcare professionals in patient's homes) care pathways, compared with hospital admission.
PRIMARY AND SECONDARY OBJECTIVES: Safety (mortality rate of all causes, in-patient, 7 days and 30 days) and readmission rate in 7 and 30 days. Length of stay in hospital and changes in pulmonary function tests.
RESULTS: One study assessed VWs (reported in two publications) and 10 assessed HaH. There were no changes in survival or short-term readmission rates attributable to the interventions and no evidence that VW or HaH care pathways reduced the total time a patient spent under hospital-led care, whether at home or in the hospital.
CONCLUSIONS: More evidence is needed to support the widespread roll-out of HaH and especially VW pathways for ECOPD. PROSPERO REGISTRATION NUMBER: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024517565.
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