The hub model: Achieving a 69% reduction in bed days and enhancing patient care in virtual health systems

This article is based on the webinar hosted by HSJ on 9 July: Using remote monitoring for long-term condition management – the Bristol Story.

As the demand for healthcare continues to grow, the adoption of virtual care has become increasingly vital. The need for efficient, scalable, and patient-centred care models is paramount. One model that has shown significant promise is the hub model.

This post explores the concept of the hub model in virtual care, its benefits, practical strategies for building such a model, challenges and solutions, and a snapshot of outcomes from the HSJ webinar on the Bristol chronic obstructive pulmonary disease initiative.

Understanding the hub model in virtual care

The hub model in virtual care is a centralised approach designed to optimise healthcare delivery through coordinated efforts. It involves a central hub that connects multiple spokes or peripheral units. This structure allows for centralised resources, expertise, and coordination while enabling localised implementation and patient interaction.

The key components of the hub model are:

1. Central coordination: The hub serves as the command centre, housing specialised healthcare providers, administrative staff, and technological resources. This centralisation ensures standardisation and quality control across the network.
2. Peripheral units (spokes): These are local healthcare facilities or community-based centres that deliver direct patient care. They rely on the hub for guidance, support, and specialised services.
3. Integrated technology: A robust IT infrastructure connects the hub and spokes, facilitating seamless communication, data sharing, and remote monitoring.
4. Patient-centric approach: The model prioritises patient needs, ensuring they receive timely, coordinated care regardless of their location.

Benefits of the hub model

The hub model offers numerous advantages, making it an attractive option for virtual care implementation. These include:

Improved patient outcomes: One of the primary benefits of the hub model is its ability to enhance patient outcomes. By centralising expertise and resources, patients receive high-quality care tailored to their needs. The hub can quickly deploy specialised services to spokes, ensuring patients get the right care at the right time. This model also supports continuity of care, reducing hospital readmissions, and improving overall health outcomes.

Efficiency and scalability: The hub model streamlines operations, making healthcare delivery more efficient. Central coordination reduces duplication of efforts and maximises resource utilisation. This efficiency is crucial for scaling virtual care services, as it allows for the rapid expansion of care delivery without compromising quality. The hub can manage a larger volume of patients and services, adapting to increasing demands seamlessly.

Building a hub model

Implementing a hub model involves careful planning and strategic execution. Here are key steps to consider:

Assessment and planning

1. Conduct a thorough assessment: Evaluate existing resources, infrastructure, and patient needs. Identify gaps and areas for improvement.
2. Develop a detailed implementation plan: Include timelines, milestones, and responsibilities. Ensure all stakeholders are aligned with the plan.

Stakeholder engagement

1. Engage key stakeholders early: Involve healthcare providers, administrative staff, and patients from the beginning. Their input and buy-in are critical for the model’s success.
2. Facilitate continuous communication: Keep stakeholders informed and engaged throughout the implementation process. Address concerns and provide updates regularly.

Technology integration

1. Invest in robust IT infrastructure: Ensure seamless communication and data sharing between the hub and spokes. The technology should be user-friendly and accessible to all stakeholders.
2. Implement data security measures: Protect patient information with stringent data protection protocols and regular system audits.

Training and support

1. Provide comprehensive training: Equip all staff members with the necessary skills and knowledge to operate within the hub model effectively.
2. Offer continuous support and education
3. Utilise a quality improvement methodology: Use an iterative approach to service development informed by patient and clinician feedback, governance, and process updates.
4. Address health inequalities in service design: Consider the provision of devices to mitigate data and digital poverty. Provide materials in multiple languages tailored to your target population’s disease profile, demographics, and area. Ensure access to translation services and accessibility features in IT and written materials.

Challenges and solutions

While the hub model offers many benefits, it also presents challenges that need to be addressed for successful implementation, such as:

Resistance to change

1. Address resistance through clear communication: Demonstrate the model’s benefits and involve staff in the transition process.
2. Provide support and resources: Offer training and support to help staff adapt to the new model.

Resource allocation

1. Ensure equitable distribution of resources: Address resource disparities, especially in under-resourced areas.
2. Monitor and adjust continuously: Regularly assess resource allocation and make adjustments as needed.

Maintaining quality

1. Develop clear guidelines and protocols: Standardisation is crucial for maintaining quality across the network.
2. Implement performance metrics: Track performance and outcomes to ensure consistent care delivery.

Data security

1. Implement stringent data protection measures: Ensure the security and privacy of patient information.
2. Conduct regular audits: Regularly audit the system to prevent data breaches and address vulnerabilities.

Snapshot: Hub model outcomes

A compelling case study from the HSJ Webinar highlighted the effectiveness of the hub model in managing COPD in Bristol. The “Living Well with COPD” programme demonstrated significant improvements, including a reduction in hospital admissions and enhanced patient self-management. 

Summary of learnings from the webinar

The HSJ webinar provided invaluable insights into the practical implementation of the hub model. Key learnings included the importance of cross-integrated care board collaboration, the role of remote monitoring, and the benefits of patient empowerment through self-management tools. There were also several early signs of impact, including:

• Reduction in bed days: One key metric showed a 69 per cent reduction in bed days among participants.
• Reduction in emergency admissions: Reflecting improved disease management.
• Support for deprived communities: The programme successfully reached and supported patients from the most deprived cohorts, demonstrating its inclusivity and effectiveness.

Other preliminary data points to reductions in accident and emergency attendance and COPD-related GP appointments, as well as high rates of smoking cessation advice provided to smokers.

The webinar highlighted the need for continued innovation and collaboration to address the challenges of chronic disease management and improve patient outcomes through the hub model.