Evaluation of the Whole System Demonstrator Project

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 number of people in the UK with a long-term condition or social care needs is expected to increase as the population ages.  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 are currently being recruited into whole system demonstrators in three sites around England: Cornwall, Kent and Newham.

About the evaluation
The evaluation of the whole system demonstrators is a randomised control trial, with an intervention group that receives telecare or telehealth, and a control group that receives usual care.  It is a complex evaluation with a multidisciplinary team, led by Professor Stan Newman at UCL, and is due to be completed towards the end of 2010.

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.  This is essential to answer the basic policy question: do these assistive technologies pay for themselves, over what time period, and in which individuals?

Working with Health Dialog, the Nuffield Trust will collect routine operational data from the sites on the utilisation of hospital, GP, community nursing and social care services, and compare utilisation between the intervention and control groups.  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. 

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).  However, as data will be pseudonymised in a consistent way we should be able to match the different datasets together.  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.

The four other themes of the evaluation are investigating:

• 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 facilitate or impede the sustainable adoption of telecare and telehealth.