Virtual healthcare compared to hospital care for acute and post-acute illness in adults: a systematic review and meta-analysis of randomised controlled trials

Aim To evaluate the clinical effectiveness, cost-effectiveness, quality of life (QoL), and patient/caregiver satisfaction associated with VWs/HaH versus traditional inpatient care in adults with acute or post-acute illness. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs), following PRISMA 2020 guidelines, registered with PROSPERO (CRD42024508457). Major databases were searched until October 2024. Primary outcomes were mortality, readmission, emergency attendance, and length of stay. Secondary outcomes were quality of life (QoL), cost-effectiveness, patient satisfaction, and caregiver burden. Meta-analyses employed random-effects models; heterogeneity was assessed using the I² statistic. Results A total of 47 reports of RCTs (9,749 patients) were included. Meta-analyses showed no statistically significant differences in mortality over 1 to 12-month periods (OR 0.82-1.11, 95% CI 0.54-1.43), readmission rates (OR 0.93 - 1.16, 95% CI 0.80-1.67), or emergency attendance rates (3-month OR 0.86, 95% CI: 0.6–1.25). Narrative synthesis indicated VWs/HaH had higher patient satisfaction and potential cost savings. Quality of life outcomes were comparable, with some improvements in pain and emotional well-being noted in home care settings. Conclusion VWs/HaH models demonstrated non-inferior clinical safety and cost-effectiveness compared to inpatient care for select adult populations. High satisfaction and comparable clinical outcomes were observed. Findings support the continued, regulated integration of virtual care into routine practice. Future research should focus on service standardisation, patient/caregiver satisfaction and support, and specific economic evaluations.