Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada.
PLoS One. 2018 Apr 30;13(4):e0196114. doi: 10.1371/journal.pone.0196114. eCollection 2018.
Unplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. Virtual Wards (VW) are an emerging concept to improve outcomes in these patients.
To evaluate the effect of post-discharge VWs, as an alternative to usual community based care, on hospital readmissions and mortality among heart failure and non-heart failure populations.
Ovid MEDLINE, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, SCOPUS and CINAHL, from inception through to Jan 31, 2017; unpublished data, prior systematic reviews; reference lists.
Randomized trials of post-discharge VW versus community based, usual care that reported all-cause hospital readmission and mortality outcomes.
Data were reviewed for inclusion and independently extracted by two reviewers. Risk of bias was assessed using the Cochrane Collaboration risk of bias tool.
In patients with heart failure, a post-discharge VW reduced risk of mortality (six trials, n = 1634; RR 0.59, 95% CI = 0.44-0.78). Heart failure related readmissions were reduced (RR 0.61, 95% CI = 0.49-0.76), although all-cause readmission was not. In contrast, a post-discharge VW did not reduce death or hospital readmissions for patients with undifferentiated high-risk chronic diseases (four trials, n = .3186).
Heterogeneity with respect to intervention and comparator, lacking consistent descriptions and utilization of standardized nomenclature for VW. Some trials had methodologic shortcomings and relatively small study populations.
A post-discharge VW can provide added benefits to usual community based care to reduce all-cause mortality and heart failure-related hospital admissions among patients with heart failure. Further research is needed to evaluate the utility of VWs in other chronic disease settings.
在日益脆弱的慢性病患者群体中，高危患者的非计划性住院治疗很常见，且费用高昂。虚拟病房（VW）是一种新兴概念，可以改善此类患者的治疗效果。
评估与常规社区护理相比，出院后 VW 作为替代方案对心力衰竭和非心力衰竭患者的住院再入院率和死亡率的影响。
通过 Ovid MEDLINE、EMBASE、PubMed、Cochrane 系统评价数据库、SCOPUS 和 CINAHL 等数据库，检索从建库至 2017 年 1 月 31 日的相关文献；同时检索未发表数据、既往系统评价及参考文献。
与常规社区护理相比，比较出院后 VW 与常规社区护理的随机试验，且均报告全因住院再入院和死亡率结果。
两位评审员独立对纳入研究进行资料提取。使用 Cochrane 协作风险偏倚评估工具评估风险偏倚。
对于心力衰竭患者，出院后 VW 可降低死亡率（6 项试验，n = 1634；RR 0.59，95%CI = 0.44-0.78）。心力衰竭相关再入院率降低（RR 0.61，95%CI = 0.49-0.76），尽管全因再入院率没有降低。相反，对于未明确区分的高危慢性病患者，出院后 VW 并不能降低死亡或住院再入院率（4 项试验，n = 0.3186）。
干预措施和对照组存在异质性，缺乏 VW 干预的一致性描述和标准化命名。部分试验存在方法学缺陷，且研究人群相对较小。
与常规社区护理相比，出院后 VW 可为心力衰竭患者提供额外的益处，可降低全因死亡率和心力衰竭相关住院率。还需要进一步的研究来评估 VW 在其他慢性疾病治疗中的效果。
