Evaluation of a virtual ward programme versus standard of care for patients with acute COPD exacerbations

Research question What are the effects, experiences, and costs of a virtual ward programme versus standard care for patients with acute COPD exacerbations? Background Virtual wards, also known as “hospital at home”, refer to provision of hospital-level care in a patient’s home. New digital technologies enable a remote connection between clinical staff and patients, allowing remote monitoring and communication with patients. Virtual wards may release capacity in hospital, while providing a preferable experience for patients. Previous randomised trials of virtual ward systems have suggested patients may have no worse or even better outcomes than in hospital, however trials have been relatively small, of mixed quality, and at the individual level, with no assessment of system level effects and implementation. Aims and objectives We will experimentally evaluate the implementation of a virtual ward programme for patients with COPD across Birmingham and Solihull. The intervention will capture patients with COPD referred through multiple care pathways, including from primary care, as early supported discharge from hospital, and via community health teams. Methods We will conduct a stepped-wedge cluster randomised trial. 120 GP clinics will be randomised to one of eleven trial sequences that will switch to the intervention from standard care with no virtual ward provision in a random, staggered order between November 2025 and March 2027. Patient eligibility for the system will be determined at the point of referral according to which GP practice they are registered at. The two primary outcomes are the total number of inpatient bed-days and risk of readmission. A sub-group analysis will consider heteroegeneity in effectiveness across socioeconomic and demographic groups. We will also conduct a comprehensive process evaluation to understand the implementation of the intervention and its barriers and facilitators for both the health service and patients and carers. We will include up to 40 patients and carers and 40 primary and secondary care clinicians. A systems-level health economic analysis will provide budget impact tools to understand the effect of the programme on patient flows and health systems costs and benefits including changes to capacity. Timelines for delivery The project will last 2.5 years, with the trial taking place from month 2 to month 18. The process evaluation will take place from month 7 to month 18. Results from the project will be made available in 2027/8. Anticipated impact and dissemination A comprehensive programme of engagement with patients, public, and healthcare bodies is planned to guide the research and support the development generalisable recommendations. Our collaboration includes local and national healthcare and patient groups to support patient and public engagement events and workshops throughout the lifetime of the project. Engagement with key national bodies including the National Respiratory Audit Program, the Society for Acute Medicine, and the NHS England Hospital at Home Advisory Group is also planned to support project impact.