Lian Leng Low|Shaohua Tan|Matthew Joo Ming Ng|Wei Yi Tay|Li Choo Ng|Kanchana D Balasubramaniam|Rachel Marie Towle|Kheng Hock Lee
Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial
Duke-NUS Medical School|Singapore General Hospital|Duke-NUS Medical School|Singapore General Hospital|Duke-NUS Medical School|Singapore General Hospital|Duke-NUS Medical School|Singapore General Hospital|Duke-NUS Medical School|Singapore General Hospital|Singapore General Hospital|Singapore General Hospital|Duke-NUS Medical School|Singapore General Hospital
background emerging evidence virtual ward care model showed multidisciplinary case management inadequate reduce readmissions death high risk patients consensus interventions encompass prehospital discharge postdischarge transitional care effective integrated practice units ipu proposed approach restructuring organization work processes multidisciplinary teams achieve value healthcare primary objective evaluate novel application ipu concept organize modified virtual ward model incorporating prehospital discharge transitional care reduce readmissions patients highest risk readmission methods conducted open label assessor blinded randomized controlled trial patients one unscheduled readmissions prior 90 days lace score 10 840 patients randomized 11 ratio blocks 6 intervention program n 420 control n 420 allocation concealment effected via offsite telephone service maintained hospital administrator intervention patients received discharge planning medication reconciliation coaching selfmanagement chronic diseases using standardized action plans individualized care plan complete written discharge instructions appointments schedule medication changes contact information outpatient vw nurse discharge discharge care handed outpatient vw team patients closely monitored vw three months included telephone review within 72 hours discharge home assessment regular telephone reviews identify early complications early review clinics patients destabilize vw meet daily discuss new patients review care plans patients control patients received standard hospital care included standardized patient copy hospital discharge summary listing medical diagnoses medications follow arranged primary care provider specialist considered necessary primary outcome unplanned readmission rate hospital within 30 days discharge secondary outcomes included unplanned readmission rate emergency department ed attendance rate hospital probability without readmission death 180 days discharge length stay mortality rate 90day compared two groups outcome data objectively retrieved hospital national electronic health records blinded outcome assessor findings patients outcomes included intentiontotreat analysis characteristics study groups similar patients intervention group significant reduction number 30day readmissions irr 067 95 ci 052 086 p 0001 number 30day emergency department attendances irr 060 95 ci 046 079 p0001 compared receiving standard hospital care effectiveness sustained 90 180 days intervention group utilized 1164 fewer hospital bed days 90day post discharge adverse events reported conclusion applying integrated practice unit concept virtual ward program resulted reduced readmissions patients highest risk readmission