New evidence for an integrated virtual ward approach

There are around 1.2 million people diagnosed with chronic obstructive pulmonary disease in the UK and its prevalence is growing – research from the University of Edinburgh has projected that there will be a 40 per cent increase, with a predicted annual cost to the NHS of £2.5bn by 2030.

COPD is known to be one of the costliest inpatient conditions treated by the NHS with nearly a third of admitted patients readmitted within three months. According to the National Institute of Health and Care Excellence, one in eight emergency hospital admissions is for a patient with COPD, which makes it the second largest cause of emergency admission in the UK. While long-term condition management of COPD resides largely within community and primary care settings, research has shown 70 per cent of COPD-related healthcare costs are for acute care following an exacerbation.

A recent Lancet paper has made eight recommendations to help eradicate COPD and suggests a COPD management algorithm that incorporates the remote assessment of patients with suspected acute exacerbations of COPD. As we approach winter, the virtual ward model could support delivery of this recommendation.

With integrated care systems tasked with increasing capacity by delivering 25,000 operational virtual beds by 2023, it is important for integrated care boards to demonstrate where they can also reduce demand. To best align with NHS long-term plan commitments, ICSs should consider an integrated approach to virtual wards that optimises long-term condition management while reducing cost and variability of care.

A recent study by NHS Greater Glasgow and Clyde examining the effectiveness of a co-designed digital service model for the management of COPD, can offer some valuable insight into how digital enabled home care for COPD may be used to maximise the impact of virtual wards spending.

Improved patient outcomes

The clinical trial at NHSGGC - the largest health board in Scotland – evaluated the Lenus COPD service for remote monitoring of people with “high-risk” COPD and found that patients on the service reported fewer community exacerbations and their risk of respiratory-related hospital admission or death was significantly lowered. Further, NICE has developed a medtech innovation briefing on the Lenus COPD Support Service for remotely managing chronic obstructive pulmonary disease.

Evidence from the trial demonstrated a 54 per cent mean reduction in admissions and 4.5 fewer occupied bed days per patient each year in those onboarded onto the service, compared to a control cohort under standard care pathways, which was controlled for the covid impact. In addition, the median time to readmission or death significantly improved from two months in the control cohort to 12 months in the COPD service users.

Early intervention

Currently, used across the NHS in Scotland and being piloted in England, the Lenus COPD Service is the only clinically evidenced technology for COPD management in the UK that combines data from patient-reported outcomes, medical and wearable devices, and electronic patient record data.

Patient health information is aggregated in a cloud-based clinical dashboard, where clinicians are presented with visualisations to better understand the likelihood of an exacerbation, allowing them to provide early intervention and prevent unnecessary hospital admissions.

The introduction of clinically actionable, AI derived, risk prediction scores, that are being trialled as part of a NHS Artificial Intelligence in Health and Care Award, will further help reorientate the management of COPD patients to a proactive and preventative model.

Reducing health inequalities

As COPD is more prevalent in communities with lower socioeconomic status, improving its management has relevance in reducing health inequalities. For this reason, COPD is one of the five clinical areas of focus in NHS England and NHS Improvement’s CORE20PLUS5 national and system level approach.

The NHSGGC trial found that deprivation demographics of Lenus COPD Service users mirrored local disease burden with nearly half of service users from the most deprived 20 per cent of the population as identified by the Scottish Index of Multiple Deprivations.

Yet, due to the usability of the platform, a high proportion of study participants continued to use it during extended follow-up - more than half of the cohort had not missed a single week of self-reporting during one year. Moreover, clinicians commented on how the sustained usage and engagement remained high throughout the trial, as patients felt empowered to self-manage their condition.

Looking to the future

Digital home care is set to be an important model to help the NHS improve services for patients with long-term conditions and address the extreme capacity issues facing the NHS that will only be exacerbated as we head into winter.

As ICSs make plans to deliver 40-50 virtual beds per 100,000 population, there is compelling evidence to focus on respiratory-related admissions by provisioning virtual wards that seamlessly transition to supporting COPD management, predict flare-ups and prevent costly inpatient care, as part of a long-term sustainable service.