It is now accepted dogma that much of the health cost that might be avoided is in hospitalizations and emergency room visits for chronic disease patients, particularly elderly ones. The emergence of relatively low cost and highly functional telecommunications capabilities has encouraged programs designed to better monitor and manage the care of these patients in their homes. Great Britain has a model called the “virtual ward” which is described in a recent Commonwealth Foundation Brief. (Commonwealth Brief)
The “virtual ward” provides many of the same elements as hospital care, but in the patient’s home. A multidisciplinary team uses the same processes and collects the same information as if the patient were in the hospital. The patients are selected using predictive modeling aimed at finding people most likely to be hospitalized in the next year. A case manager nurse leads the team, which significantly includes a social worker. Regular rounds are held to review patients and there is constant communication among the providers.
While an economic assessment has not yet been completed, there is some evidence of hospitalization savings. Patients in the program have a higher level of satisfaction, as do the members of the virtual ward provider team. Remote monitoring technologies and other telecommunications use are key in coordinating care. The program is generally low cost, with little need for capital equipment and use of existing staff. While clear evidence of the financial consequences is needed, it already appears that such models, including Guided Care in the United States, are capable of improving quality.