What is the evidence for virtual wards or hospital-at-home care pathways for exacerbations of chronic obstructive pulmonary disease? A systematic review and meta-analysis.
Clinical Snapshot
PICO Framework
| P — Population | Adults with exacerbations of chronic obstructive pulmonary disease (ECOPD) presenting to hospital or requiring hospital-led care |
| I — Intervention | Virtual wards (remote assessments/interventions) or hospital-at-home (HaH) care pathways with healthcare professionals delivering care in patient homes |
| C — Comparator | Standard hospital admission and inpatient care |
| O — Outcomes | Primary: all-cause mortality (inpatient, 7-day, 30-day), readmission rates (7-day, 30-day). Secondary: length of hospital stay, changes in pulmonary function tests |
Bottom Line
This systematic review found insufficient evidence to support widespread implementation of virtual wards or hospital-at-home pathways for COPD exacerbations. Despite theoretical benefits of admission avoidance, the limited available evidence shows no significant improvements in mortality, readmission rates, or total time under hospital care. Only one study examined virtual wards, highlighting a critical evidence gap. For Australian clinicians, while these models align with healthcare efficiency goals, the current evidence base is too limited to justify routine implementation. More high-quality randomised controlled trials are needed before these alternative care models can be recommended as standard practice for COPD exacerbations requiring hospital-level intervention.
Key Findings
P Value: Not reported in abstract
Effect Size: Not reported in abstract
Primary Outcome: No significant differences in all-cause mortality at inpatient, 7-day, or 30-day timepoints
Nnt Or Sensitivity: No significant reduction in readmission rates at 7 or 30 days
Confidence Interval: Not reported in abstract
Clinical Application
Implementation requires healthcare infrastructure for remote monitoring or home-based professional care delivery Relevant to Australian healthcare given interest in admission avoidance strategies. Would need consideration of PBS funding for remote monitoring technology and workforce capacity for home-based care delivery Adults with COPD exacerbations requiring hospital-level care in healthcare systems with capacity for alternative care delivery models
Abstract
OBJECTIVES: Given increasing interest in admission avoidance, we evaluated the evidence to support virtual wards (VW) and hospital at home (HaH) models of care during exacerbations of chronic obstructive pulmonary disease (ECOPD). DESIGN: A systematic review and meta-analysis. A comprehensive search of MEDLINE (1946 to March 2024), Embase (1974 to March 2024) and CENTRAL (searched 22 March 2024) was conducted. Risk of bias and a random effects meta-analysis were performed. POPULATION: Adults with an ECOPD presenting to the hospital or who require hospital-led care. INTERVENTIONS: VW: defined as assessments and interventions delivered remotely or HaH (defined as assessments and interventions delivered by healthcare professionals in patient's homes) care pathways, compared with hospital admission. PRIMARY AND SECONDARY OBJECTIVES: Safety (mortality rate of all causes, in-patient, 7 days and 30 days) and readmission rate in 7 and 30 days. Length of stay in hospital and changes in pulmonary function tests. RESULTS: One study assessed VWs (reported in two publications) and 10 assessed HaH. There were no changes in survival or short-term readmission rates attributable to the interventions and no evidence that VW or HaH care pathways reduced the total time a patient spent under hospital-led care, whether at home or in the hospital. CONCLUSIONS: More evidence is needed to support the widespread roll-out of HaH and especially VW pathways for ECOPD. PROSPERO REGISTRATION NUMBER: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024517565.
References
- 1.Alenazi, B., Hatton, C., & Sapey, E. (2026). What is the evidence for virtual wards or hospital-at-home care pathways for exacerbations of chronic obstructive pulmonary disease? A systematic review and meta-analysis. BMJ Open Respiratory Research. https://doi.org/10.1136/bmjresp-2025-003611
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