Early Transfer of Hospitalized Patients Including COVID-19 Patients to a Virtual Hospital at Home(vHaH)Model -a Clinical Feasibility Study.

This study 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 in the home, as a substitute for a continued inpatient hospital admission. An underlying rationale for the development of vHaH is that, by avoiding the hospital environment, fragile and older persons may experience high-quality care that is associated with fewer complications, and higher treatment satisfaction for patients and their families. Various versions of home-hospital models have been implemented during the COVID-19 pandemic crisis, but in many situations out of need and so far, only very limited documented experience from sound research approaches is available in the medical literature. This study will be a clinical feasibility study, which will be used to guide the framing and design of the final telemedicine supported vHaH model for hospitalized patients including epidemic patients. We apply our experience from 5 months of clinical small scale testing (Sept 2021 - Jan 2022) of the light version of the final vHaH model on hospitalized patients (the technology and workflows of the vHaH model were tested by in-patients under their hospital stay) to implement this novel model in the safest possible way. The vHaH model will be offered exclusively to moderately ill (not severely ill) patients with respiratory infections including COVID-19.

The overall aim of Influenz-er, is to develop and implement a novel telemedicine monitoring and communication model, that will enable safe admission of epidemic patients in their homes. We will implement this novel model in the safest possible way, and initially offer the vHaH model to patients conventionally admitted with COVID-19 illness or other lower respiratory tract infections causing pneumonia. Conversion to vHaH admission will be effectuated after an assessment by a medical infectious disease specialist if the patient is assessed to be ready to continue the hospital admission safely from home, under continued monitoring and treatment responsibility by the hospital.

Based on a Cochrane review this innovative alternative to conventional hospitalization, is expected to benefit patients who will remain in the comfort of their own homes. This model could potentially increase patient and next of kin quality of life and treatment satisfaction, decrease risks of nosocomial complications and increase availability of emotional support from next of kin.

A hospital based Virtual Epidemic Center (VEC) is the center of the project, from where medical staff will monitor and communicate with patients admitted at home. Vital parameters and patient reported outcomes will be collected using a smart phone/tablet-based app. All data will be collected and processed in an algorithm to predict the impact of changes on disease severity. Algorithm and direct patient data will be displayed in real-time at the hospital in the VEC, allowing medical staff to continuously monitor their patients. In addition, daily virtual ward rounds conducted by staff in the VEC and when relevant by medical doctors (MD) from specialties of relevance to the patients' illness(es) will ensure close communication and relevant clinical assessments. A mobile medical team consisting of nurses and medical doctors (MD), will perform in-person patient evaluations, administer medication and perform other required daytime routine medical tasks.

The Influenz-er project governance structure consists of a Steering Committee with representation by the project partners Nordsjællands Hospital, University of Southern Denmark and Innovation Fund Denmark, an international Advisory Board and a national Consulting Group. Head of Clinical Research at Nordsjællands Hospital, Professor Thea Kølsen Fischer is principle investigator and project manager. The project team includes clinical experts with expertise within management of COVID-19 as well as health economic senior experts, PhD students, administrative research and innovation coordinators and health tech developers.