title: Do 'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls.
abstract: BACKGROUND
  This retrospective study will assess the extent to which multidisciplinary case management in the form of virtual wards (VWs) leads to changes in the use of health care and social care by patients at high risk of future unplanned hospital admission. VWs use the staffing, systems and daily routines of a hospital ward to deliver coordinated care to patients in their own homes. Admission to a VW is offered to patients identified by a predictive risk model as being at high risk of unplanned hospital admission in the coming 12 months.
  We will compare the health care and social care use of VW patients to that of matched controls. Controls will be drawn from (a) national, and (b) local, individual-level pseudonymous routine data. The costs of setting up and running a VW will be determined from the perspectives of both health and social care organizations using a combination of administrative data, interviews and diaries.
  
  
  METHODS
  Using propensity score matching and prognostic matching, we will create matched comparator groups to estimate the effect size of virtual wards in reducing unplanned hospital admissions.
  
  
  CONCLUSIONS
  THIS STUDY WILL ALLOW US TO DETERMINE RELATIVE TO MATCHED COMPARATOR GROUPS: whether VWs reduce the use of emergency hospital care; the impact, if any, of VWs on the uptake of primary care, community health services and council-funded social care; and the potential costs and savings of VWs from the perspectives of the national health service (NHS) and local authorities.
authors.affiliation: The Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK.
authors.forename: Geraint
authors.initials: G
authors.lastname: Lewis
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
authors.forename: Rhema
authors.initials: R
authors.lastname: Vaithianathan
authors.forename: Adam
authors.initials: A
authors.lastname: Steventon
authors.forename: Theo
authors.initials: T
authors.lastname: Georghiou
authors.forename: John
authors.initials: J
authors.lastname: Billings
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dixon