Patient demographics, diagnoses, and care needs in a Norwegian Community Virtual Ward versus Skilled Nursing Facility - a longitudinal comparative cohort study

Sep 30, 2026

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Patient demographics, diagnoses, and care needs are compared between a municipality Community Virtual Ward (CVW) and a traditional Skilled Nursing Facility (SNF) in Norway to assess CVW feasibility as an alternative to institutional care for older home residents. A longitudinal comparative cohort study followed 55 participants transitioning from hospital to either CVW or SNF, collecting demographics, frailty, functional independence, and service use at admission, discharge, and 3 months post-discharge. CVW participants were younger with fewer chronic conditions and lower frailty, while baseline frailty and discharge function predicted recovery and 90-day service utilization.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background

Methods

Results

Conclusion

Keywords

Correspondence

Jones et al. BMC Health Services Research (2026) 26:31 BMC Health Services Research [https://doi.org/10.1186/s12913-025-13827-x](https://doi.org/10.1186/s12913-025-13827-x) RESEARCH Open Access Patient demographics, diagnoses, and care needs in a Norwegian Community Virtual Ward versus Skilled Nursing Facility: a longitudinal comparative cohort study Emma Sigridsdatter Jones 1,2*, Sine Maria Herholdt-Lomholdt2, Annelise Norlyk3 and Francis Odeh 1,4 Abstract Background Since the early 2000s, Virtual Wards have referred to models where patients receive care at home rather than in traditional healthcare facilities. In 2021, the municipality of Bodø, Norway established a Community Virtual Ward (CVW) model, offering enhanced medical follow-up for older home residents. Unlike previous models, this CVW is fully municipality operated, features broad inclusion criteria, and includes a dedicated physician. The initiative responds to challenges related to longevity, frailty and task-shifting from hospitals to primary care. This study aimed to compare patient demographics and care needs between a CVW and a traditional Skilled Nursing Facility (SNF), and to access whether the CVW model can serve as a viable alternative to institutional care. Methods A longitudinal comparative cohort study was conducted with 55 participants transitioning from hospital to either a CVW or a SNF. Data on demographics, frailty, functional independence, and service utilization were collected at admission, discharge, and three months post-discharge. Descriptive and regression analyses were used to identify predictors of recovery and service needs. Results CVW patients were younger, had fewer chronic conditions, lower frailty levels, and shorter admission periods compared to SNF patients. Across both groups, baseline frailty and functional independence at discharge were key determinants of recovery and service utilization 90 days post-discharge. Differences between groups were statistically significant for frailty, functional scores, and length of stay. Comorbidities were associated with smaller improvements during the inpatient stay but did not predict longer-term recovery. Conclusion The findings suggest that the CVW model is a viable alternative to short-term institutional care for mildly frail patients who benefit from rehabilitation-focused, home-based services. SNFs remain essential for frailer individuals requiring intensive support. The results highlight the need for systematic frailty assessment in primary care to optimize care pathways for aging populations. Keywords Primary healthcare, Municipal healthcare services, Virtual ward, Community virtual ward, Skilled nursing facility, Frailty, Patient characteristics *Correspondence: Emma Sigridsdatter Jones [emma.sigridsdatter.jones@bodo.kommune. no](emma.sigridsdatter.jones@bodo.kommune. no) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. Jones et al. BMC Health Services Research (2026) 26:31 Background Longevity stands among society’s greatest achievements but al

FAQs

What was the main aim of the study?

To compare patient demographics and care needs between a CVW and a SNF and to assess whether the CVW model can serve as a viable alternative to institutional care.

How was the study conducted and what data were collected?

A longitudinal comparative cohort study followed 55 participants transitioning from hospital to either CVW or SNF, collecting demographics, frailty, functional independence, and service utilization at admission, discharge, and three months after discharge.

What differences were observed between CVW and SNF patients?

CVW patients were younger, had fewer chronic conditions, lower frailty levels, and shorter admission periods. Differences were statistically significant for frailty, functional scores, and length of stay.

What factors predicted recovery and service utilization after discharge?

Baseline frailty and functional independence at discharge were key determinants of recovery and service utilization 90 days post-discharge.

Sep 30, 2026

Uploaded by Stanford