TY  - JOUR
AU  - Melman, Alla
AU  - Teng, Min Jiat
AU  - Coombs, Danielle M
AU  - Li, Qiang
AU  - Billot, Laurent
AU  - Lung, Thomas
AU  - Rogan, Eileen
AU  - Marabani, Mona
AU  - Hutchings, Owen
AU  - Maher, Chris G
AU  - Machado, Gustavo C
PY  - 2024
DA  - 2024/2/22
TI  - A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study
JO  - JMIR Res Protoc
SP  - e50146
VL  - 13
KW  - length of stay
KW  - back pain
KW  - musculoskeletal pain
KW  - telemedicine
KW  - hospital-based home care
KW  - mobile phone
KW  - home care
KW  - virtual care
KW  - remote care
KW  - virtual hospital
KW  - pain
KW  - telehealth
KW  - eHealth
KW  - musculoskeletal
KW  - implementation
KW  - model of care
KW  - back
KW  - cost
KW  - economic
KW  - readmission
KW  - hospital stay
AB  - Background: Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. Objective: The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. Methods: This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an “audit and feedback” process. The implementation of “Back@Home” will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. Results: As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). Conclusions: This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. International Registered Report Identifier (IRRID): PRR1-10.2196/50146 
SN  - 1929-0748
UR  - https://www.researchprotocols.org/2024/1/e50146
UR  - https://doi.org/10.2196/50146
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38386370
DO  - 10.2196/50146
ID  - info:doi/10.2196/50146
ER  -