A community virtual ward model to support older persons with complex health care and social care needs

C Lewis,1 Z Moore,1 F Doyle,2 A Martin,3 D Patton,1 LE Nugent1 1School of Nursing and Midwifery, Royal College of Surgeons Ireland, 2Department of Psychology, Royal College of Surgeons in Ireland, 3Beaumont Hospital, Dublin, Ireland Background: Globally the older population is increasing rapidly. As...

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Autores principales:	Lewis C, Moore Z, Doyle F, Martin A, Patton D, Nugent LE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Community Virtual Ward Case Management Integrated Care Older Persons Care Complex Care. Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/7b73ec86888347409ab38b6d92744f3e
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spelling	oai:doaj.org-article:7b73ec86888347409ab38b6d92744f3e2021-12-02T02:50:11ZA community virtual ward model to support older persons with complex health care and social care needs1178-1998https://doaj.org/article/7b73ec86888347409ab38b6d92744f3e2017-06-01T00:00:00Zhttps://www.dovepress.com/a-community-virtual-ward-model-to-support-older-persons-with-complex-h-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998C Lewis,1 Z Moore,1 F Doyle,2 A Martin,3 D Patton,1 LE Nugent1 1School of Nursing and Midwifery, Royal College of Surgeons Ireland, 2Department of Psychology, Royal College of Surgeons in Ireland, 3Beaumont Hospital, Dublin, Ireland Background: Globally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.Methods: A quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre- and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s p test.Results: There was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.Conclusion: Through an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.Keywords: community virtual ward, case management, integrated care, older persons’ care, complex careLewis CMoore ZDoyle FMartin APatton DNugent LEDove Medical PressarticleCommunity Virtual WardCase ManagementIntegrated CareOlder Persons CareComplex Care.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 985-993 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Community Virtual Ward Case Management Integrated Care Older Persons Care Complex Care. Geriatrics RC952-954.6
spellingShingle	Community Virtual Ward Case Management Integrated Care Older Persons Care Complex Care. Geriatrics RC952-954.6 Lewis C Moore Z Doyle F Martin A Patton D Nugent LE A community virtual ward model to support older persons with complex health care and social care needs
description	C Lewis,1 Z Moore,1 F Doyle,2 A Martin,3 D Patton,1 LE Nugent1 1School of Nursing and Midwifery, Royal College of Surgeons Ireland, 2Department of Psychology, Royal College of Surgeons in Ireland, 3Beaumont Hospital, Dublin, Ireland Background: Globally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.Methods: A quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre- and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s p test.Results: There was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.Conclusion: Through an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.Keywords: community virtual ward, case management, integrated care, older persons’ care, complex care
format	article
author	Lewis C Moore Z Doyle F Martin A Patton D Nugent LE
author_facet	Lewis C Moore Z Doyle F Martin A Patton D Nugent LE
author_sort	Lewis C
title	A community virtual ward model to support older persons with complex health care and social care needs
title_short	A community virtual ward model to support older persons with complex health care and social care needs
title_full	A community virtual ward model to support older persons with complex health care and social care needs
title_fullStr	A community virtual ward model to support older persons with complex health care and social care needs
title_full_unstemmed	A community virtual ward model to support older persons with complex health care and social care needs
title_sort	community virtual ward model to support older persons with complex health care and social care needs
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/7b73ec86888347409ab38b6d92744f3e
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A community virtual ward model to support older persons with complex health care and social care needs

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