Skip to main navigation menu Skip to main content Skip to site footer

Research Article

Vol. 18 No. 1 (2020)

The family medicine based virtual ward: Qualitative description of the implementation process

July 22, 2019


Purpose: Chronically ill older patients transitioning from hospital to home are at increased risk of readmission and complications. Numerous transitional care interventions have been proposed to improve communication and continuity of care throughout the transition. Evidence suggests that the risk of readmission and complications is reduced when interventions provide closer follow-up and multidisciplinary care. Informed by this evidence, the family medicine based virtual ward was developed by a Montreal family medicine group (FMG) to provide home-based care for patients with an elevated risk of emergency department (ED) visit or hospital readmission. The virtual ward team provides comprehensive, multidisciplinary post-discharge care at patients’ homes, combining the systems and staffing of the FMG’s home care program with a nurse case manager. Research was conducted to inform the implementation of similar transitional care programs in other Quebec health care settings. Methods: This research consists of a retrospective qualitative descriptive study of the implementation of the family medicine based virtual ward. Data was obtained from a semi-structured group interview with the team and informal interviews with individual members. Inductive thematic content analysis was used. Results: The following were identified as conditions for its successful implementation: 1) funding, 2) home care, 3) communication, 4) protocol standardization, and 5) continuous quality improvement. Conclusions: This intervention addresses the care of frequent health system users and compensates for gaps in communication and coordination. It was well-received by patients, healthcare providers and health system administrators and has the potential to reduce readmissions and reduce health system costs.


  1. Kahn JM, Angus DC. Going home on the right medications: prescription errors and transitions of care. JAMA. 2011;306(8):878-9.
  2. Bogaisky M, Dezieck L. Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: patterns and risk factors. J Am Geriatr Soc. 2015;63(3):548-52.
  3. Epstein AM, Jha AK, Orav EJ. The relationship between hospital admission rates and rehospitalizations. N Engl J Med. 2011;365(24):2287-95.
  4. Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Annals of emergency medicine. 2002;39(3):238-47.
  5. Mistiaen P, Francke AL, Poot E. Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC Health Serv Res. 2007;7:47.
  6. Le Berre M, Maimon G, Sourial N, Gueriton M, Vedel I. Impact of Transitional Care Services for Chronically Ill Older Patients: A Systematic Evidence Review. J Am Geriatr Soc. 2017;65(7):1597-608.
  7. Lewis G. Predictive Modeling in Action: How ‘Virtual Wards’ Help High-Risk Patients Receive Hospital Care at Home. Issues in International Health Policy, Commonwealth Fund pub 2010;1430(94):1-16.
  8. Dhalla IA, O'Brien T, Morra D, Thorpe KE, Wong BM, Mehta R, et al. Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial. JAMA. 2014;312(13):1305-12.
  9. Lewis C, Moore Z, Doyle F, Martin A, Patton D, Nugent LE. A community virtual ward model to support older persons with complex health care and social care needs. Clin Interv Aging. 2017;12:985-93.
  10. Lewis G, Georghiou T, Steventon A, Viathianathan R, Chitnis X, Billings J, et al. Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis. Final report. National Institute for Health Research Service Delivery and Organisation programme. Southampton: National Institute for Health Research; 2013. Available from:
  11. Lewis G, Wright L, Vaithianathan R. Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada. Popul Health Manag. 2012;15(5):315-21.
  12. van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551-7.
  13. Detsky AS, Krumholz HM. Reducing the trauma of hospitalization. Journal of the American Medical Association. 2014;311(21):2169-70.
  14. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000(23):334-40.
  15. Green LW, George MA, Daniel M, Frankish CJ, Herbert CJ, Bowie WR, et al. Study of participatory research in health promotion. Review and recommendations for development of participatory research in health promotion in Canada Ottowa, Ontario: The Royal Society of Canada. 1995.
  16. Jary D, Jary J. Collins dictionary of sociology. Glasgow: Collins; 2005.
  17. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.
  18. Vedel I A-LG, Ladores M, Saad H, Sourial N, Gagnon J, D'Souza V, Kremer B. Effect of a Primary Care Virtual Ward on the readmission rates of older patients post discharge. 21st IAGG World Congress of Gerontology and Geriatrics; San-Francisco, United States2017.
  19. Schoen C, Osborn R, How SK, Doty MM, Peugh J. In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Aff (Millwood). 2009;28(1):w1-16.
  20. Charlie Fidelman. Quebec's electronic records plan a 'disaster,' Barrette says. Montreal Gazette. 2014 November 21, 2014.
  21. Billings J, Mijanovich T. Improving The Management Of Care For High-Cost Medicaid Patients. Health Affairs. 2007;26(6):1643-54.
  22. Lewis G, Bardsley M, Vaithianathan R, Steventon A, Georghiou T, Billings J, et al. Do'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls. International journal of integrated care. 2011;11:e079-e.


Download data is not yet available.