early discharge - evaluating a virtual hospital at home model

Conditions: Epidemic Disease; Infections

Summary: this controlled clinical trial will be part of a larger, 'virtual hospital-at-home' (vhah) project called influenz-er. vhah is a care model designed to deliver medical care at home, as a substitute for a continued conventional inpatient hospital admission. the overall aim of influenz-er is to develop, implement and evaluate a novel hospital at home model, that will enable safe and satisfactory admission of hospitalised patients including epidemic patients in their homes.

various versions of hospital-at-home models have been implemented as an emergency solution to a steep increase in number of hospitalisations during the covid-19 pandemic crisis. conventionally, epidemic patients who require medical monitoring, will be admitted to the hospital. recently, patients hospitalised for covid-19 requiring medical supervision for an extended period - sometimes for weeks - have been admitted to their own home supported by telemedicine and/or mobile hospital-based care team (mhct). various models of home-based admissions of pandemic patients have been implemented internationally with great results regarding safety and effectiveness. these models are mostly based on physical attendance of physicians in the patient's home and in most situations implemented out of need. home-based models provide promising results regarding costs, but results are based on low-quality evidence. health systems facing capacity constraints and rising costs needs to allocate resources based on high-quality evidence. therefore, further research regarding feasibility, safety, satisfaction, costs, and effectiveness of a vhah model still needs to be done. danish hospital capacity will not allow for hah models primarily depending on physical attendance of physicians in the patient's home, nor will it be possible to manually monitor all patient reported data. therefore, there is a need for a telemedicine supported vhah model with a smart algorithm alarming clinical staff and thereby aiding in timely handling of patient data and clinical state. project influenz-er proposes an option of transfer to telemedicine supported vhah model as an alternative to continued standard hospital admission for the future. patient safety is a top priority regarding both the utilised technology and the re-organisation of standard clinical responsibilities and tasks. therefore, project influenz-er included several steps prior to the effectiveness evaluation in this clinical trial. in the present study, knowledge from previous studies under project influenz-er is applied, and the vhah is now ready to be evaluated in an effectiveness trial.

Eligibility criteria:
inclusion criteria: * age 18 years or older * patients admitted to 1. the department of pulmonary and infectious diseases (dpid) under any diagnosis or 2. to the department of multimorbidity under any diagnosis * residential address within the catchment area of north zealand university hospital * treatment regimen which can be handled within the vhah model exclusion criteria: * unstable clinical condition defined by a current early warning score (ews) \> 6 or single score = 3. * permanent physical or cognitive impairment or observed non-compliance that might negatively affect the ability to perform any of the required actions during the intervention such as self-measurements, data transfer by the app, and/or communication via telephone or video consultation. a. this may include, but is not limited to conditions such as dementia, post-stroke sequelae, deafness, extreme tremor of the upper limbs. * unproficiency in danish language skills * pregnancy

Keywords: telemedicine hospital at home