Examining the effectiveness of Virtual Wards

Area of work:

Evaluation, Integrated care, Predictive risk

As the NHS looks for new ways of helping patients to avoid the need for unplanned hospital admission, researchers at the Nuffield Trust have conducted an evaluation of an innovative scheme called Virtual Wards, which has the potential to prevent readmissions using predictive modelling.

Many NHS organisations use computer models (called ‘predictive models’) to help them identify individuals who are at high-risk of future hospital admissions, so that these people can be offered extra support to keep them healthier and hopefully avoid the need for emergency admissions.

In certain parts of the NHS in England, such people are being offered extra support through a system of ‘Virtual Wards’. These aim to prevent unplanned admissions by using the systems of a hospital ward to provide multidisciplinary case management in the community. The Virtual Wards work just like a hospital ward, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

This project will find out what effect – if any – Virtual Wards have on the use of health and social care services

Health and social care professionals work together to provide patients with multidisciplinary, preventive care at home using the same coordination as that of a hospital ward team. The Virtual Ward team meets together for ‘ward rounds’, they use the same notes for documentation, and have an administrator called a ‘ward clerk’ to keep them organised and to pass on messages.

Researchers at the Nuffield Trust have evaluated the costs and benefits of the Virtual Wards in Croydon, Devon and Wandsworth, with funding from the National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) programme.

This research aimed to find out how much it costs to run a Virtual Ward, and what effect – if any – they have on the use of health and social care services. The findings, which will be published in spring 2013, should help councils and the NHS decide whether to fund Virtual Wards and how best to run them.

Methodological approach

We used two research techniques for this project called ‘difference in difference analysis’ and ‘economic analysis’.

The first technique involved comparing the hospital use of Virtual Ward patients to similar groups of patients to see whether there are any differences. We used pseudonymous data (data from which patients’ identities have been removed to ensure confidentiality) to analyse patterns of hospital, GP and social care use in the three areas. We identified all those individuals who received care on a Virtual Ward, and tracked their use of health and social care services over time.

We then compared the hospital use of the people who received Virtual Ward care with similar patients (called ‘comparator’ groups) drawn from national and local data to see whether there were any differences.

The second technique, ‘economic analysis’, involved working closely with the Virtual Ward staff, their managers and finance officers, to understand how Virtual Wards work in practice. Administrative data, interviews and diaries were used to calculate the costs of setting up and running a Virtual Ward.

Once we gathered all of this information, we pulled it together to work out the overall costs or savings for the NHS and local authorities, and this was used to develop a method by which councils and PCTs can choose between different arrangements of Virtual Wards locally.