Since the pandemic, virtual healthcare is moving forward and it will become a commodity. That doesn’t mean health and care will be fully digital. Of course not: in-person contacts will always be necessary and valuable.
But as chronic diseases are the real battle to fight in modern medicine, and as the need for healthcare professionals explodes (due to aging of HC staff and the effects of the pandemic workload), hybrid care might be the future-proof answer.
In the current hybrid care-debate, 3 questions regularly pop up:
- Where and how can we implement hybrid health care? What’s the perfect trade-off between digital and traditional care?
- Who is doing it already?
- What’s the demonstrated impact of hybrid care? (Why should I care?)
When we consider the practical implementation of digital health into European health systems, hybrid care is the realistic answer. Because it builds real integrated care journeys and brings value-based models for financing, starting from fee-for-service, closer.
So: Where is hybrid care a perfect fit?
1) Hybrid GP practice
Hybrid care is perfect for GP practices since there is a digital variant for allmost all care and services here. So patients do not always have to come to the practice.
Moreover, GP’s are faced with a large numer of chronic patients who require routine follow-up. The digital transformation of the GP practice can offer an answer to the general shortage of GPs, the administrative workload of the doctor and his or her skewed work-life balance.
To implement a hybrid practice, the GP first provides various access points to the patient: online, by telephone, video and physical. Practical aspects such as making appointments, requesting repeat prescriptions or viewing results online are thus digitised. The patient can keep track of a number of measurements at home, fill in questionnaires and request information about certain treatments.
The Dutch Patients’ Federation believes hybrid GP practices should be self-evident and ‘the patient has the right to choose digital care’ . They also advocate the use of artificial intelligence technology by GP’s, for example for pre-triage and alerting.
This is supported by the Dutch health insurer CZ group, who considers virtual care as basic care and finance it in this way. Their motto? hybrid care is appropriate care. That’s why they recently set up the Knowledge Center digital care.
2) Hybrid maternity care
In case of normal childbirth, women in Belgium stay for an average 3 days in hospital. The European average was 2,8 days in 2016. And in 2020, women in Canada and the UK left hospital after 1,5 day on average after delivery.
As a consequence, care for mother and child shifts from maternity care in the hospital to home care. In Belgium, due to changes in the model, midwives started making home visits. Government supported this by upgrading the nomenclature and paying a premium for the use of a digital patient file.
Research on the effect of virtual care in perinatal care in the US during the covid pandemic showed that virtual home visits were feasible and provided an essential connection between families and caregivers during the lockdown period. These findings were confirmed in a study that examined the effect of implementing virtual care in an existing pre- and postnatal care program, called the Welcome Baby Home Visiting Program.
But although current perinatal care for (future) mothers is an example of emerging hybrid care, there is still room for improvement:
- the covid pandemic introduced video consultations by midwifes, but communication between physical visits is still often via text messages because of the low threshold.
- this permanent availability can have impact on the midwife’s work-life balance
- but integrated hybrid care paths, thus including planned virtual care, could alleviate the digital growing pains of maternity care.
No doubt, the future of perinatal care is hybrid. The homogeneous group of (younger) patients involved is perfectly suited to implement hybrid care models.
3) The hybrid hospital
As (energy and infrastructure) costs in hospitals keep on growing and as multiple hospital CEO’s are confronted with shortage of nursing staff, exacerbated by the pandemic, they are moving towards hybrid care.
For example, US-top health system Mayo Clinic has set up a ‘hybrid care hotel’ for post-operative patients since 2020. The aim was to speed up recovery, reduce medical costs and optimise the hospital’s bed capacity. Patients can choose freely to check in at the hybrid care hotel after orthopaedic surgery, minimally invasive back surgery and low-risk urological interventions. During working hours, the care hotel employed one nurse responsible for wound care and monitoring vital parameters. During the night, patients were virtually monitored.
The results of this experiment were recently published. The authors concluded that the patients experienced the care hotel as positive. The patient’s privacy was more respected and there was more room for contact with relatives(12). The hybrid model ‘bolsters patient satisfaction’ and is ‘safe, happy and cheap’, says the medical director of the hospital in Florida.
A next step is the ‘virtual hybrid hospital at home’ or ‘advanced care at home’ model (ACH). Here, all required medical ‘in hospital’- care is provided at home (consulting physician, nurse, monitoring, laboratory, medication administration). Mayo Clinic had been experimenting with such kind of services for 25 years, but has now adapted it to scale up better.
In general, the advanced care at home model (ACH) leads to high quality and safe patient care and simultaneously reduces hospital costs and improves the patient experience. After all, the care is more individually “patient centered” and the home environment speeds up recovery.
The ACH model at Mayo Clinic uses a stable internet connection at the patient’s home that allows for good video communication. Biosensors and wearables monitor the patient’s vital parameters. Every 3 to 6 hours the patient is evaluated. The doctor visits the patient every day virtually. A home care nurse visits the patient twice a day. The care is coordinated by a command center led by a specialised nurse. This center can take various actions: activating a rapid response team, scheduling blood tests, a nursing visit or consulting medical imaging. Patient education and advanced care planning are included too.
In April 2022, results of the new virtual hospital at home program were published. Patient report good experiences. Communication with healthcare providers scored high, just as easy use of equipment and quick discharge from hospital.
Although both examples focus on rather general patient groups and their experience, we do have data on specific medical services and the impact on specific patient groups too.
Radiologic imaging, for example, is also very well suited for hybrid service.
Demonstrated impact of hybrid speciality care
Of course, hybrid care should be more than a buzzword. Its real practice is about finding the best trade-off between physical or traditional care and digital care, with the best possible patient experience and outcomes.
We share but a few of these valuable insights on the impact of hybrid:
- Cleveland clinic and better follow-up for chronic pain patients
- Mental healthcare and genetic counseling for cancer patients
- Better quality of life for palliative patients
- Patient security and less medication errors after surgery
Thanks to Wouter DC, co-author of this article.