Telehealth and telecare are examples of assistive technologies that aim to improve outcomes for people with long-term health conditions or social care needs. They may also reduce use of hospitals and care homes. We are part of a major randomised controlled trial to assess the impact and effectiveness of these technologies.
Co-author Adam Steventon outlines the first findings of the Nuffield Trust’s analysis of the Whole System Demonstrator trial.
The Nuffield Trust is leading one aspect of a large-scale evaluation of telecare and telehealth:
- Telehealth may help people with long-term health conditions such as diabetes, heart failure and chronic obstructive pulmonary disease. It refers to the remote exchange of data between an individual and a health care professional, and aims to assist in the diagnosis and management of conditions. Examples include blood pressure monitoring, blood glucose monitoring and medication reminders.
- Telecare has been designed for people with social care needs and means the remote monitoring of an individual’s condition or lifestyle. It aims to manage the risks of independent living. Examples include automatic movement sensors, falls sensors, and bed occupancy sensors.
In 2006, the Department of Health announced the establishment of three pilots, known as the ‘Whole System Demonstrators’, to test the benefits of integrated health and social care supported by assistive technologies like telecare and telehealth.
We believe that with over 3,000 participants, this study is the largest randomised trial of telehealth in the world
We are leading one strand of an evaluation of the Whole System Demonstrator trial, concerning the impact of telehealth on use of hospitals and mortality. This is important as investment in telehealth has often been justified on the basis of cost savings through reduced hospital use.
Our first findings have now been published in the research summary: The impact of telehealth on use of hospital care and mortality (June 2012) and in an article in the British Medical Journal.
In the trial – the largest of its kind to be conducted thus far – over 3,000 patients were recruited from three areas of England (Cornwall, Kent and Newham) to receive telehealth or to act as controls by receiving usual care. We found that:
- Control patients experienced 0.68 emergency hospital admissions per head on average over the 12 months of the trial. In comparison, telehealth patients experienced 0.54 on average. This is a difference of 0.14 emergency admissions per head, or around 20 per cent.
- There were fewer deaths among telehealth patients than controls (4.6 per cent of telehealth patients compared with 8.3 per cent of controls).
- Hospital inpatient and outpatient costs were around £188 lower for telehealth patients than controls over 12 months. However, these differences were not statistically significant at conventional levels so could have been the result of chance. Further, the cost of the intervention will need to be offset against these estimates (this information is forthcoming).
- There are reasons to be cautious about the results. For example, emergency admissions appeared to increase for control patients shortly after being recruited into the trial. The article and research summary discuss these issues in further detail.
Our work used innovative data matching techniques to build up a picture of each participant’s health and social care use. We extracted over a billion records of administrative data from more than 250 health and social care organisations.
To protect data confidentiality, we used pseudonymisation, which involves replacing a patient identifier such as an NHS number with a code that cannot be traced back to an individual (see the diagram below). The project also involved the implementation of the Combined Model, which was used in case-mix adjustment.
Click on the image to enlarge
It was a complex evaluation with a multidisciplinary team led by Professor Stan Newman at University College London (now at City University). The four other themes of the evaluation are:
- participant/carer reported outcomes and clinical effectiveness;
- costs and cost effectiveness;
- experiences of service users, informal carers and health and social care professionals;
- organisational factors that help or hinder sustainable adoption of these technologies.
Findings from the other evaluation themes are forthcoming. As well as telehealth, the trial also tested a system of telecare and findings in relation to this are due to be published in late 2012.
