NIHR Policy Research Unit in Behavioural and Social Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Health Determinants Research Collaboration, Gateshead Council, Gateshead, United Kingdom.
J Med Internet Res. 2024 Nov 27;26:e56494. doi: 10.2196/56494.
Virtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees involved in the planning of, agreeing to, and monitoring of services within NHS England and have an important role in the adoption and implementation of VWs in clinical practice.
This study aims to develop an understanding of the acceptability and feasibility of adopting and implementing VWs in England from integrated care system commissioners' perspectives, including the identification of barriers and facilitators to implementation.
Qualitative semistructured interviews were conducted with 20 commissioners employed by NHS England (NHSE) in various geographic regions of England. Thematic analysis was conducted, structured using the framework approach, and informed by the Consolidated Framework for Implementation Research. The COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines were followed.
Four overarching themes were identified reflecting the acceptability and feasibility of key adoption and implementation processes: (1) assessing the need for VWs, (2) coordinating a system approach, (3) agreeing to Program Outcomes: NHSE Versus Organizational Goals, and (4) planning and adapting services. Commissioners expressed the need for system-level change in care provision within the NHS, with VWs perceived as a promising model that could reform patient-centered care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also uncertainty over the extent to which VWs should be technology-enabled, and the specific ways technology may enhance condition-specific pathways. Differing interpretations of the NHSE instructions between different health care sectors and a lack of clarity in definitions, as well as use of hospital-centric language within national guidance, were considered hindrances to convening a system approach. Furthermore, narrow parameters of success measures in terms of goals and outcomes of VWs, unrealistic timescales for planning and delivery, lack of interoperability of technology and time-consuming procurement procedures, liability concerns, and patient suitability for technology-enabled home-based care were identified as barriers to implementation. Motivated and passionate clinical leads were considered key to successful implementation.
VWs have the potential to reform patient-centered care in England and were considered a promising approach by commissioners in this study. However, there should be greater clarity over definitions and specifications for technology enablement and evidence provided about how technology can enhance patient care. The use of less hospital-centric language, a greater focus on patient-centered measures of success, and more time allowance to ensure the development of technology-enabled VW services that meet the needs of patients and staff could enhance adoption and implementation.
虚拟病房（VW）作为向原本需要住院的患者提供护理的新方式，正在英格兰的国民保健服务（NHS）中推出。通过数字技术，患者可以在自己家中接受急性护理、远程监测和治疗。综合护理系统专员参与 NHS 英格兰服务的规划、协商和监测，在 VW 在临床实践中的采用和实施中发挥着重要作用。
本研究旨在从综合护理系统专员的角度了解在英格兰采用和实施 VW 的可接受性和可行性，包括确定实施的障碍和促进因素。
对在英格兰不同地理区域工作的 20 名 NHS 英格兰（NHSE）员工进行了定性半结构式访谈。采用框架方法进行主题分析，并以实施研究的综合框架为指导。遵循 COREQ（定性研究报告的统一标准）准则。
确定了四个总体主题，反映了 VW 关键采用和实施过程的可接受性和可行性：（1）评估 VW 的需求，（2）协调系统方法，（3）同意方案结果：NHSE 与组织目标，以及（4）规划和调整服务。专员们表达了对 NHS 内提供护理的系统级变革的需求，认为 VW 是一种有前途的模式，可以改革以患者为中心的护理。然而，对于 VW 的财务可持续性存在不确定性，有人质疑是否会通过关闭医院床位来为 VW 提供资金。对于 VW 应该在多大程度上实现技术化，以及技术可以增强特定疾病路径的具体方式，也存在不确定性。不同卫生保健部门对 NHSE 指示的不同解释，以及国家指导方针中缺乏明确性和使用以医院为中心的语言，被认为是阻碍系统方法的因素。此外，在 VW 的目标和结果方面，成功措施的参数范围狭窄，规划和交付的时间安排不切实际，技术的互操作性和耗时的采购程序缺乏，责任问题以及患者是否适合基于技术的家庭护理，这些都被认为是实施的障碍。有动力和热情的临床负责人被认为是成功实施的关键。
VW 有可能改革英格兰的以患者为中心的护理，并且在这项研究中被专员们认为是一种有前途的方法。然而，应该对技术实现的定义和规范有更明确的认识，并提供有关技术如何增强患者护理的证据。使用较少以医院为中心的语言，更关注以患者为中心的成功衡量标准，以及更多的时间来确保开发满足患者和员工需求的技术化 VW 服务，可以增强采用和实施。
