{
  "abstract": "Background Virtual wards (VWs) deliver technology-enabled, multidisciplinary care to patients in their own home, with the aim of reducing hospital admissions and length of stay. They have been rapidly adopted across the NHS in England; however strategic implementation research is limited. This study explored commissioners’ perceptions and experiences of implementing VWs within integrated care systems (ICSs) in England.Methods We co-produced this research with NHS England colleagues to ensure relevancy and opportunity for translation of evidence into practice. We used a longitudinal qualitative design, with semi-structured online interviews conducted with commissioners involved in the implementation of VWs at two timepoints (TP), six months apart; TP1 (n = 20) and TP2 (n = 14). Data were analysed using the updated Consolidated Framework for Implementation Research (CFIR) within the Framework Method. The CFIR comprises five overarching domains: Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process.Results Implementation progress varied across sites, with some scaling back due to challenges and others expanding their VW programmes. The Inner Setting domain (e.g., ICS structures and culture) appeared most influential over time, while the Individuals domain (e.g., clinician attitudes) became less prominent. Key barriers to implementation included limited staff capacity (Inner Setting), funding uncertainty (Outer Setting), inequalities in patients’ home environments (Outer Setting), lack of clinician buy-in (Individuals), and insufficient implementation planning (Implementation Process). Facilitators to implementation included leveraging existing services (Innovation), collaborative working (Inner Setting), and having adaptable national guidance (Implementation Process). Commissioners reported high patient acceptability and a preference for home-based care (Outcomes).Conclusion VWs, when offered as an alternative (not replacement) to hospital care, exemplify person-centred care. Successful implementation requires clinician engagement, cross-sector collaboration, strategic planning at the ICS level, and sustainable funding. To prevent exacerbating health inequalities, additional tailored support should be provided to disadvantaged patients.",
  "authors": [
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Laura McGowan"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Beth Nichol"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Jan Lecouturier"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Helen Banks"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Centre for Preventive Medicine and Digital Health (CPD), Heidelberg University, Mannheim, Germany"
      ],
      "name": "Raenhha Dhami"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"
      ],
      "name": "Michael Kelly"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Centre for Preventive Medicine and Digital Health (CPD), Heidelberg University, Mannheim, Germany"
      ],
      "name": "Falko Sniehotta"
    },
    {
      "affiliations": [
        "NIHR Policy Research Unit in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Fiona Graham"
    }
  ],
  "title": "P16-6 Implementing virtual wards in integrated care systems in England: a longitudinal qualitative study of commissioner perspectives",
  "uid": "6e2cc068-1f22-5e91-a935-e8750b995bc3"
}