A Mixed Methods Quality Improvement Evaluation of a Dedicated Virtual Rounding Team for Home Hospital Care

Background Importance Home hospital is the delivery of acute, hospital-level care at home as a substitute for traditional brick-and-mortar care. Most past literature includes a care model where home hospital providers visit the patient at home. Due to the inefficiencies of travel, newer models incorporate more remote medicine, although the evidence base is less robust. Our home hospital program practices in a hybrid model, where providers choose to see their patients virtually or in the home. Objective We evaluated whether a dedicated virtual rounding provider alongside the traditional in-home rounder would streamline care. Methods Design, Setting & Participants We deployed a virtual rounding line that cared for a select group of lower-complexity patients (while the rest were cared for by traditional in-home rounders) in our North (intervention) but not South (control) geography. Outcomes Our primary outcome was a composite of adverse events (AEs) per hundred patients. We performed multivariable regression with a difference-in-differences (DiD) approach. We analyzed qualitative provider experience surveys. Results We studied 230 patients (83 North; 147 South). The median age was 77, 57% were female, and 86% spoke English. Groups differed by race/ethnicity and education. In the primary DiD analysis, there was no significant difference in AEs (intervention, 4[pre] vs 3[post]; control, 17[pre] vs 18[post]; DiD, -1.1 [95% CI, -12.2 to 10.1]). There was no significant difference in length of stay (intervention, 5.2[pre] to 5.5[post]; control, 5.7[pre] vs 5.1[post]; DiD, 0.9 [95% CI, -0.6 to 2.3]) or 30-day readmission (intervention, 14[pre] to 12[post]; control, 16[pre] vs 10[post]; DiD, 6.8 [95% CI, -4.5 to 18.2]). Qualitative themes included difficulty scheduling, difficulty applying VR criteria, loss of continuity of care, and increased travel for in-home rounders because virtual rounders were taken out of the field. Conclusion Virtual rounding for select patients is likely associated with no difference for AEs, length of stay, or 30-day readmission, although replication would be beneficial, and the narrower slice of patients who can be cared for virtually may limit virtual rounding. Providers qualitatively found virtual rounding challenging compared to traditional rounding.