Telecare and telehealth are new technologies designed to help people with long-term conditions maintain their independence and reduce the need for hospital and care home use. We are part of a major randomised controlled trial to assess the impact and effectiveness of these new technologies.
The Nuffield Trust is leading one aspect of a large-scale evaluation of telecare and telehealth. Telecare and telehealth are assistive technologies designed to help people with long-term conditions or social care needs maintain their independence and to reduce unnecessary hospital and care home use.
- Telecare means the remote monitoring of an individual’s condition or lifestyle, and aims to manage the risks of independent living. Examples include automatic movement sensors, falls sensors, and bed occupancy sensors;
- Telehealth means the remote exchange of data between an individual and a healthcare professional, and aims to assist in the diagnosis and management of health care conditions. Examples include blood pressure monitoring, blood glucose monitoring, and medication reminders.
The 2006 Department of Health White Paper, Our health, our care, our say: a new direction for community services, proposed to establish whole system demonstrators to test the benefits of integrated health and social care supported by assistive technologies like telecare and telehealth. Individuals were recruited into whole system demonstrators in three sites around England: Cornwall, Kent and Newham.
We believe with nearly 6,000 participants this study is the largest randomised trial of these technologies in the world
The evaluation is a randomised control trial, with an intervention group that receives telecare or telehealth, and a control group that receives usual care. Though these technologies are increasingly common there are few randomised controlled evaluations of their effectiveness. In fact we believe with nearly 6,000 participants this study is the largest randomised trial of these technologies in the world. It is a complex evaluation with a multidisciplinary team, led by Professor Stan Newman at UCL (now at City University), and is due to be completed in 2012.
The Nuffield Trust is leading Theme 1 of the evaluation, which is investigating the impact of telecare and telehealth on the use of NHS and social services, and the associated costs. We will use innovative data matching techniques to build up a picture of each participant’s health and social care use over the trial period and compare the intervention and control groups.
To protect data confidentiality, we will use pseudonymisation, which involves replacing a patient identifier such as an NHS number with a code that cannot be traced back an individual (see the diagram below). The project also involves the implementation of the Combined Model, which will be used to stratify the analysis by the risk attached to each person in the trial of emergency hospital admission.
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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 telecare and telehealth.
The results from the evaluation will be published in spring 2012. The Nuffield Trust will separately publish a range of reports and articles describing the results from its investigations into the initial impact of telecare and telehealth on the use of NHS and social services, and the associated costs in spring 2012.
