The BRIDGE Study

Improving Chronic Obstructive Pulmonary Disease (COPD) care at home by evaluating an enhanced virtual ward service for patients.

Chief Investigator (CI)

Professor Sam Watson
Professor of Biostatics
Staff profile page for Sam Watson, Senior Lecturer at the Department of Applied Health Sciences.

Virtual wards, also known as “hospital at home”, refer to provision of hospital-level care in a patient’s home. New digital technologies enable a remote connection between clinical staff and patients, allowing remote monitoring and communication with patients. Virtual wards may release capacity in hospital, while providing a preferable experience for patients. Previous randomised trials of virtual ward systems have suggested patients may have no worse or even better outcomes than in hospital, however trials have been relatively small, of mixed quality, and at the individual level, with no assessment of system level effects and implementation. In this project, we will experimentally evaluate the implementation of a virtual ward programme for patients with COPD across Birmingham and Solihull. The intervention will capture patients with COPD referred through multiple care pathways, including from primary care, as early supported discharge from hospital, and via community health teams.

We will conduct the BRIDGE (Birmingham Research in Integrated Digital General care Environments) study, which is a stepped-wedge cluster randomised trial. This is funded by the National Institute of Health and Care research (NIHR) Health and Social Care Delivery Research (HSDR) Programme. The pragmatic study design will allow us to integrate a rigorous evaluation during the routine roll-out of a virtual ward programme. All GP practices in the study area (n=178) will serve as the clusters, which will be randomised to one of eleven trial sequences that will serve as the basis to expand eligibility to the intervention to patients in a random, staggered order between December 2025 and March 2027.

The trial will enable us to evaluate the effects of the virtual ward intervention across the health system in Birmingham and Solihull, including changes in referral behaviour and levels of care received. We focus on both implementation and effectiveness; our two primary outcomes are the total number of inpatient bed-days and risk of readmission. A sub-group analysis will consider heterogeneity in effectiveness across socioeconomic and demographic groups.

Study Team:

Co-Chief Investigator: Professor Samuel Watson

Co-Chief Investigator and Clinical Lead: Dr Paul Ellis

Co-Applicant and Clinical and Health Services Lead: Professor Alice Turner

Co-Applicant and Health Economics Lead: Dr James Hall

Co-Applicant and Virtual Ward and Evidence Synthesis Lead: Professor Elizabeth Sapey

Co-Applicant and Qualitative Lead: Dr Agnieszka Ignatowicz

Co-Applicant: Professor Daniel Lasserson

Co-Applicant and PPI Co-ordinator: Dr Anita Pye

Participant recruitment

Eligibility criteria

We provide a description of the study population below. However, we note that no prospective recruitment or sampling of patients will take place as part of the trial. The staggered roll-out of the intervention will be integrated into routine service delivery, and patient data will all be captured retrospectively from routine data sources.

Inclusion criteria

Clusters

The project will be based within the catchment area of University Hospitals Birmingham Foundation Trust, which includes 178 GP practices and three referral hospitals (Queen Elizabeth, Good Hope, Heartlands). The GP practices form the basis of randomisation since this has already been a factor in determining eligibility for services in the region (geographical inequity), thus is feasible to continue to use, but in a structured way, which will eventually abrogate the geographical inequity by bringing all areas into the service as part of planned service expansion.

Individuals

We will retrospectively identify all patients on the COPD register for each GP in the catchment area for the data analysis. No patients will be recruited prospectively. Our primary data sample for the quantitative analysis will consist of all admitted spells of care during the study period for these patients. We include all patients by design so that the trial is inclusive and capable of assessing any differences in care provision by protected characteristics, for example different proportions of enrolment to the virtual ward by ethnicity, age or socio-demographic factors.

Exclusion criteria

There are no exclusion criteria for either clusters or individuals. However, we provide a mechanism for patients to withdraw access to their data on request.

Recruitment

No patients are recruited to the study prospectively. The implementation of the intervention is taking place as part of normal service improvement activities, and the staggered implementation is required to evaluate the intervention and takes place as part of quality improvement. The research poses little to no risk to patients or clinicians. We will therefore not seek informed consent from patients or clinicians in this trial. However, we will offer patients an opt-out of the use of their data in the study.

We will produce informational documents for patients with COPD to provide information about the trial and use of personal data. We will first create posters to be displayed in GP clinics describing the study and providing contact information for the PPI liaison for the study. We will also create leaflets providing the same information that will be distributed to patients in secondary and community care settings. All participant information documents will be translated into the six most commonly spoken languages in the area after English (Urdu, Arabic, Bengali, Hindi, Somali, and Romanian).

Contact us

Email the BRIDGE Study team: bridge@contacts.bham.ac.uk