Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland.
Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland.
Ir J Med Sci. 2022 Apr;191(2):615-621. doi: 10.1007/s11845-021-02633-z. Epub 2021 May 6.
Chronic respiratory diseases are responsible for significant patient morbidity, mortality, and healthcare use. Community virtual ward (CVW) models of care have been successfully implemented to manage patients with complex medical conditions.
To explore the feasibility and clinical outcomes of a CVW model of care in patients with chronic respiratory disease.
Patients known to specialist respiratory services with Chronic Obstructive Pulmonary Disease (COPD) and/or asthma were admitted to the CVW for disease optimisation and exacerbation management. Individualised management plans were delivered in the patients' home by hospital-based respiratory and community nursing teams, incorporating remote technology to monitor vital signs. Symptoms and health status at admission and discharge were compared.
Twenty patients were admitted. One-quarter of patients had asthma, 50% COPD, and 25% combined asthma/COPD. Patients had severe disease, mean (SD) FEV 50(20) % predicted, and an average 6.4(5.7) exacerbations of disease in the previous 12 months. Patients received personalised disease and self-management education. All acute exacerbations (n = 11) were successfully treated in the community. The average length of CVW admission was 10(4) days. By discharge, 60% of COPD and 66% of asthma patients recorded improvements in symptoms score exceeding the minimal clinically important difference. Fifty percent had clinically meaningful improvements in health status.
A CVW model facilitates the delivery of combined specialist and generalist care to patients with chronic respiratory disease in the community and improves symptoms and health status. The principles of the model are transferable to other conditions to improve overall health and reduce emergency hospital care.
慢性呼吸系统疾病会导致患者发病率、死亡率和医疗保健使用率显著增加。社区虚拟病房（CVW）护理模式已成功用于管理患有复杂医疗条件的患者。
探索慢性呼吸系统疾病患者 CVW 护理模式的可行性和临床结果。
患有慢性阻塞性肺疾病（COPD）和/或哮喘的专科呼吸服务患者被收治到 CVW 病房进行疾病优化和加重期管理。由医院呼吸科和社区护理团队在患者家中提供个性化管理计划，并结合远程技术监测生命体征。比较入院和出院时的症状和健康状况。
共收治 20 例患者。四分之一的患者患有哮喘，50%患有 COPD，25%同时患有哮喘/COPD。患者病情严重，FEV1 预测值为 50(20)%，过去 12 个月平均有 6.4(5.7)次疾病加重。患者接受了个性化的疾病和自我管理教育。所有急性加重（n=11）均在社区成功治疗。CVW 住院平均时间为 10(4)天。出院时，60%的 COPD 患者和 66%的哮喘患者的症状评分改善超过最小临床重要差异。50%的患者健康状况有显著改善。
CVW 模式能够为社区中患有慢性呼吸系统疾病的患者提供专家和全科医生的联合护理，并改善症状和健康状况。该模式的原则可适用于其他疾病，以改善整体健康状况并减少急诊住院治疗。
