Improving the quality and sustainability of home-based acute care models using virtual care technology

Abstract

Importance COVID-19 has facilitated the rise of a new service model that combines HITH service provision with technology to create ‘virtual hospitals’, but evidence on the impact of this new model in terms of cost and clinical outcomes, compared to usual Hospital in the Home (HITH) care, is currently lacking. Objective To assess the clinical and financial impacts of virtual care technology on Hospital in the Home models of care. Design Quasi-experimental study comparing outcomes of a control group receiving ‘usual’ home-based acute care and a virtual care cohort using remote monitoring technology while also receiving usual Hospital in the Home (HITH) care. Main Outcomes and Measures Readmissions within 28 days, unplanned emergency department (ED) presentations, transfers-in to facility-based hospital beds, and average length of stay. Results During the study period, 151 adult and 26 paediatric patients utilised virtual care technology for the majority, or all, of their home-based acute care. Use of such technology was associated with a statistically significant reduction in risk of hospital readmission within 28 days—from 43% to 21%. The risk of hospital readmission within 28 days for the same diagnosis-related group (DRG) dropped from 18% to 4%, and the length of stay for the top three DRGs by volume decreased from a mean of 7.2 days to 4.0 days, saving an average of $3,698 per admission. Use of technology was also associated with reduced rates of unplanned ED presentations and transfers-in to traditional hospital beds compared to usual care for adults. Conclusions Our findings confirm there are clinical and economic benefits associated with embedding virtual care technology in Hospital in the Home (HITH) service models that warrant consideration in health systems facing capacity constraints and rising costs.