We are indebted to all of the services that participated in this study and to all of the patients, carers and staff who participated in our surveys and interviews. Thank you to the following: Dr Jennifer Bousfield for supporting with study design and data collection, Simon Barnes for supporting with data entry; Jon Sussex for advice given throughout the project; our NIHR BRACE and NIHR RSET PPI members (Raj Mehta, Tina Coldham, June Sadd, Richard Allen, Trevor Fernandes and Fola Tayo) for providing feedback throughout the study and for commenting on drafts of chapters; the NIHR 70@70 Senior Nurse Research Leaders for providing feedback on the development of our study; Russell Mannion for peer-reviewing our study protocol; the NIHR Clinical Research Networks for supporting study set-up and data collection; PHE and the Institute of Global Health Innovation, NIHR Patient Safety Translational Research Centre, Imperial College London, NHSEI and Kent, Surrey and Sussex Academic Health Sciences Network for providing data; Cono Ariti (University of Cardiff) for statistical advice; and Eilís Keeble (Nuffield Trust) for her approach to classifying COVID-19 spells in HES. We thank the NHS Digital CO@h Evaluation Workstream Group chaired by Professor Jonathan Benger and NHSX (in particular Breid O’Brien and Chris Richmond) for facilitating and supporting the evaluation, and to the other two evaluation teams for their collaboration throughout this evaluation: (1) Institute of Global Health Innovation, NIHR Patient Safety Translational Research Centre, Imperial College London; and (2) the IAU (partnership between the Health Foundation and NHSEI). Many thanks to our clinical advisory group for providing insights and feedback throughout the project: Dr Karen Kirkham (whose previous role was the Integrated Care System Clinical Lead, NHSE/I Senior Medical Advisor Primary Care Transformation, Senior Medical Advisor to the Primary Care Provider Transformation team), Dr Matt Inada-Kim (Clinical Lead Deterioration and National Specialist Advisor Sepsis, National Clinical Lead – Deterioration and Specialist Advisor Deterioration, NHS England & Improvement) and Dr Allison Streetly (Senior Public Health Advisor, Deputy National Lead, Healthcare Public Health, Medical Directorate NHS England).
Contributions of authors
Naomi J Fulop (https://orcid.org/0000-0001-5306-6140) (Professor of Health Care Organisation and Management) was the principal investigator and led the overall evaluation. She led on, and contributed to conception, design, analysis and write-up of all aspects of the study, and is lead author of this report.
Holly Walton (https://orcid.org/0000-0002-8746-059X) (Research Fellow) contributed to design and data collection of workstreams 3 and 4 (phase 2), co-led the analysis for the implementation and patient experience chapters, and supported analysis of the workforce chapter. She contributed to the design and interpretation of all other aspects of the study (phase 2). She was involved in contributing to the drafting of the final report (including drafting Chapters 1, 2 and 12, leading/co-leading Chapters 4 and 9, and supporting Chapter 8).
Nadia Crellin (https://orcid.org/0000-0002-9497-5874) (Fellow) contributed to design and data collection of workstreams 3 and 4 (phase 2), co-led the analysis for the implementation and disparities chapters, and supported analysis of the workforce and modality chapter. She contributed to the design and interpretation of all other aspects of the study (phase 2). She was involved in contributing to the drafting of the final report (including leading/co-leading Chapters 4 and 10 and supporting Chapters 2, 8 and 11).
Theo Georghiou (https://orcid.org/0000-0001-9532-876X) (Senior Fellow) contributed to design and data collection of the Phase 1 study and workstream 1 (Phase 2), led on the effectiveness of virtual wards chapter and supported on the effectiveness of CO@h chapter. He contributed to the design and interpretation of all other aspects of the study. He was involved in contributing to the drafting of the final report (including leading Chapter 6 and supporting on Chapters 2 and 5).
Lauren Herlitz (https://orcid.org/0000-0003-2497-9041) (Research Fellow) contributed to design and data collection of workstreams 3 and 4 (phase 2), led the analysis for the modality chapter, and supported analysis of the disparities chapter. She contributed to the design and interpretation of all other aspects of the study (phase 2). She was involved in contributing to the drafting of the final report (including leading Chapter 11 and supporting Chapters 2 and 10).
Ian Litchfield (https://orcid.org/0000-0002-1169-5392) (Research Fellow) contributed to design and data collection of workstreams 3 and 4 (phase 2) and lead/co-lead the analysis for the implementation chapter. He contributed to the design and interpretation of all other aspects of the study (Phase 2). He was involved in contributing to the drafting of the final report (including co-leading Chapter 4 and supporting Chapter 2).
Efthalia Massou (https://orcid.org/0000-0003-0488-482X) (Research Associate) contributed to design and data collection of workstream 2 (phase 2), and co-lead on the cost analysis chapter. She contributed to the design and interpretation of all other aspects of the study (phase 2). She was involved in contributing to the drafting of the final report (including co-leading Chapter 7 and supporting Chapter 2).
Chris Sherlaw-Johnson (https://orcid.org/0000-0002-4851-6060) (Senior fellow) contributed to design and data collection of the Phase 1 study and workstream 1 (phase 2). He led on the effectiveness of CO@h chapter and supported on the effectiveness of virtual wards chapter. He contributed to the design and interpretation of all other aspects of the study (phases 1 and 2). He was involved in contributing to the drafting of the final report (including leading Chapter 5 and supporting on Chapters 2 and 6).
Manbinder Sidhu (https://orcid.org/0000-0001-5663-107X) (Research Fellow) contributed to design and data collection of the phase 1 study and workstreams 3 and 4 (phase 2). He led the analysis for the workforce chapter, and supported analysis of the disparities chapter. He contributed to the design and interpretation of all other aspects of the study (phases 1 and 2). He was involved in contributing to the drafting of the final report (including leading Chapter 8 and supporting Chapters 2 and 11).
Sonila M Tomini (https://orcid.org/0000-0002-4241-2121) (Research Fellow) contributed to design and data collection of the phase 1 study and workstream 2 (phase 2), and co-lead on the cost analysis chapter. She contributed to the design and interpretation of all other aspects of the study (phases 1 and 2). She was involved in contributing to the drafting of the final report (including co-leading Chapter 7 and supporting Chapter 2).
Cecilia Vindrola-Padros (https://orcid.org/0000-0001-7859-1646) (Senior Research Fellow) contributed to design and data collection of the phase 1 study, and workstreams 3 and 4 (phase 2). Cecilia led the analysis for phase 1, and supported analysis of the patient experience and modality chapters. She contributed to the design and interpretation of all other aspects of the study (phases 1 and 2). She was involved in contributing to the drafting of the final report (including leading Chapter 3 and supporting Chapters 2 and 9).
Jo Ellins (https://orcid.org/0000-0001-8138-9385) (Senior Fellow) contributed to the design and analysis of all aspects of the evaluation, in particular supporting with analysis and interpretation of findings relating to workstreams 3 and 4, and supported with drafting of the final report.
Stephen Morris (https://orcid.org/0000-0002-5828-3563) (Professor of Health Services Research) contributed to the design and analysis of all aspects of the evaluation, led and oversaw workstream 2, and supported with drafting the final report.
Pei Li Ng (https://orcid.org/0000-0001-8411-220X) (Project Manager) led on the project management of the evaluation and supported with drafting of the final report.
All authors contributed to integrating the findings of the study. All authors made critical revisions to the report content and approved the final manuscript. All authors agree to be accountable for all aspects of this work in ensuring that questions related to the accuracy or integrity of any part of the final report are appropriately investigated and resolved.
Publications
Published:
Georghiou T, Sherlaw-Johnson C, Massou E, Morris S, Crellin NE, Herlitz L, et al. The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: a national observational study using hospital activity data. eClinicalMedicine 2022;48:101441. doi: https://doi.org/10.1016/j.eclinm.2022.101441
Greenhalgh T, Knight M, Inda-Kim M, Fulop NJ, Leach J, Vindrola-Padros C. Remote management of covid-19 using home pulse oximetry and virtual ward support. BMJ 2021;372:n677. https://doi.org/10.1136/bmj.n677
Sherlaw-Johnson C, Georghiou T, Morris S, Crellin N, Litchfield I, Massou E, et al. The impact of remote home monitoring of people with COVID-19 using pulse oximetry: a national population and observational study. EClinicalMedicine 2022;45:101318. https://doi.org/10.1016/j.eclinm.2022.101318
Sidhu MS, Ford GA, Fulop NJ, Roberts CM. Learning networks in the pandemic: mobilising evidence for improvement. BMJ 2022;379:e070215. https://doi.org/10.1136/bmj-2022-070215
Sidhu M, Walton H, Crellin N, Ellins J, Herlitz L, Litchfield I, et al. Staff experiences of training and delivery of remote home monitoring services for patients diagnosed with COVID-19: a mixed-methods study. J Health Serv Res Policy 2023;0(0). https://doi.org/10.1177/13558196231172586
Vindrola C, Fulop N, Greenhalgh T. Virtual wards: caring for COVID-19 patients at home could save lives. The Conversation. 2020. URL: https://theconversation.com/virtual-wards-caring-for-covid-19-patients-at-home-could-save-lives-149292 (accessed 18 July 2023).
Vindrola-Padros C, Sidhu MS, Georghiou T, Sherlaw-Johnson C, Singh KE, Tomini SM, et al. The implementation of remote home monitoring models during the COVID-19 pandemic in England. EClinicalMedicine 2021;34:100799. https://doi.org/10.1016/j.eclinm.2021.100799
Vindrola-Padros C, Singh KE, Sidhu MS, Georghiou T, Sherlaw-Johnson C, Tomini SM, et al. Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review. EClinicalMedicine 2021;37:100965. https://doi.org/10.1016/j.eclinm.2021.100965
Walton H, Crellin N, Sidhu MS, Sherlaw-Johnson C, Herlitz L, Litchfield I, et al. Undertaking rapid evaluations during the COVID-19 pandemic: Lessons from evaluating COVID-19 remote home monitoring services in England. Front Sociol 2023;8:982946. https://doi.org/10.3389/fsoc.2023.982946
Walton H, Fulop NJ. Virtual wards and Covid-19: An explainer. Nuffield Trust. 2022. URL: www.nuffieldtrust.org.uk/resource/virtual-wards-and-covid-19-an-explainer (accessed 18 July 2023).
Walton H, Vindrola-Padros C, Crellin N, Sidhu MS, Herlitz L, Litchfield I, et al. Patients’ and carers’ experiences of, and engagement with remote home monitoring services for COVID-19 patients: a rapid mixed-methods study. Health Expectations 2022:25:2386–404. https://doi:10.1111/hex.13548.
Preprints/submitted for review
Crellin N, Herlitz L, Sidhu MS, Ellins J, Georghiou T, Litchfield I, et al. Examining disparities relating to service reach and patient engagement with COVID-19 remote home monitoring services in England: a mixed-methods rapid evaluation. medRxiv 2021. https://doi.org/10.1101/2022.02.21.22270793
Herlitz L, Crellin N, Vindrola-Padros C, Ellins J, Georghiou T, Litchfield I, et al. Technology-enabled and analogue models of remote home monitoring care for COVID-19: a rapid mixed-method evaluation of patient and staff experiences. Submitted for publication June 2023.
Ethical approval
Phase 1 received ethical approval from the University of Birmingham humanities and social sciences ethics committee (ERNE_13-1085AP37) and was categorised as a service evaluation by the Health Research Authority (HRA) decision tool and University College London/University College London Hospitals (UCL/UCLH) Joint Research Office. The study protocol was divided into two separate protocols: (1) covered workstreams 1 and 2 and the staff elements of workstreams 3 and 4, received ethical approval from the University of Birmingham Humanities and Social Sciences ethics committee (ERN_13-1085AP39) and was categorised as a service evaluation by the HRA decision tool and UCL/UCLH Joint Research Office (January 2021); (2) the patient experience study (survey and case study interviews – workstreams 3 and 4) was reviewed and given favourable opinion by the London-Bloomsbury Research Ethics Committee (REC reference: 21/HRA/0155 (February 2021).
Data-sharing statement
Individual patient-level data and data supplied under specific data-sharing agreements cannot be made available by the study team. Sources for data that are already publicly available are supplied either in the text or the references. Aggregate survey data collected by the study team are presented within this final report. The anonymised qualitative data that support the findings of this study are available on request from the corresponding authors. To protect anonymity of interviewees, the data are not publicly available. Further information can be obtained from the corresponding authors.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme [(RSET: 16/138/17; BRACE: 16/138/31) and NHSEI] and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
Disclaimers
This report presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.