A community virtual ward model to support older persons with complex health care and social care needs
Received 22 December 2016
Accepted for publication 22 March 2017
Published 26 June 2017 Volume 2017:12 Pages 985—993
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
C Lewis,1 Z Moore,1 F Doyle,2 A Martin,3 D Patton,1 LE Nugent1
1School of Nursing and Midwifery, Royal College of Surgeons Ireland, 2Department of Psychology, Royal College of Surgeons in Ireland, 3Beaumont Hospital, Dublin, Ireland
Background: Globally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.
Methods: A quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre- and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s p test.
Results: There was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.
Conclusion: Through an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.
Keywords: community virtual ward, case management, integrated care, older persons’ care, complex care
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