The Whole System Demonstrator project Prof Stanton Newman Principal Investigator
Overall AimAim: to provide a comprehensive evaluation of theaddition of telecare and telehealth to whole systemsre-design.Project planned to assess up to 6,000 individuals andup to 660 carers with a variety of methods and levelsof analysis.
WSD Evaluation Cluster RCT design Group A Group B Group C Group D Social Care needs Social Care needs receive usual care Social Care needs Social Care needs receive usual care receive telecare receive telecare (CONTROL GROUP) (CONTROL GROUP) LTCs receive usual care LTCs receive usual careLTCs receive telehealth LTCs receive telehealth (CONTROL GROUP) (CONTROL GROUP)
Theme 1THEME 1 OVERALL AIM OF NO. PARTICIPANTS EVALUATION THEME REQUIREDDoes the introduction To identify the impact of TH 5721 participants & TC on NHS and socialof telehealth or care utilisation and costs intelecare result in trial versus control groups,reduction in service across the wholeutilisation and costs programme and the three sites.of care?Impact on service use and It will also identify anyassociated costs for the NHS impact on health & careand social services (return utilisation and costson investment). compared to trends observed in similar cases inCombined Model + England.Community/Social CareAnalysis
Total Numbers recruited Target 5721 Recruited: 5831 1200Intervention Control 1117 1111 Control Intervention 2881 2949 1057 49% 51% 1010 1000 800 775 760 600 Newham, 400 1535, 26% Cornwall, 2228, 38% 200 Kent, 2067, 36% 0 Cornwall Kent Newham
Total Numbers recruited Mean Deprivation Score Mean Deprivation Score60.0 60.050.0 50.040.0 40.0 28.3 28.3 27.7 28.830.0 30.020.0 20.010.0 10.0 0.0 0.0 Control Intervention Male Female Mean Deprivation Score60.050.0 44.840.030.0 25.5 18.820.010.0 0.0 Cornwall Kent Newham
Theme 2THEME 2 OVERALL AIM OF EVALUATION NO. PARTICIPANTS THEME REQUIREDParticipant reported 1. Does the use of telecare reduce 3160 participants informal carer burden and socialoutcomes 470 informal carers isolation and improve psychological well−being?What is the effect on 2. What is the impact of telehealthcarer burden, self- packages on self−care behaviours, self−efficacy and empowerment incare behaviours and people with long term conditions?quality of life? 3. What factors predict the use and impact of (a) telecare and (b)What predicts telehealth amongst service userswhether people will and informal carers?use the service as 4. What are the mechanisms by whichplanned? (a) telecare and (b) telehealth may impact on service user and informal carer outcomes e.g. empowerment, quality of life?
Theme 3THEME 3 OVERALL AIM OF EVALUATION NO. PARTICIPANTS THEMECost and To assess cost −effectiveness of the 3160 participants introduction of TH and TC, 470 informal carerscost−effectiveness investigating the typical resource inputs Professional and identifying the routine activities that interviewsWhat is the are associated with the interventions. It will determine what a typical carecost−effectiveness package for a TH or TC user is and willof the introduction of further seek to assess the impact oftelecare? this on the use of healthcare, social care and benefits.What is the Finally, this theme will seek tocost−effectiveness understand if the use of TH or TC asof the introduction of part of a care package improves the self-reported quality of life of servicetelehealth? users and their carers.
WSD QuestionnairesPsychological Well-beingBrief STAI Short form state anxiety measureCES-D 10 Short form Depression ScaleQuality of LifeUK SF12 Measure of health-related quality of lifeEQ-5D Measure of health outcome – also utilized for QALYsMLHFQ Minnesota Living with Heart Failure Questionnaire - measure of patients perceptions of the effects of congestive heart failure on their livesCRQ Chronic Respiratory Questionnaire - measure of quality of life for patients with chronic lung diseaseDHP Diabetes Health profile – disease specific quality of life measureTDS Townsend Disability index of activities that assesses physical ability in social terms (12mth & EUS)
WSD QuestionnairesSelf-care behavioursEHFSCB European Heart Failure Self Care Behaviours scale measures behaviours that heart failure patients perform to maintain life, healthy functioning, and well-beingCOPD-SCB Chronic Obstructive Pulmonary Disease Self-Care behaviours scaleSDSCA Summary of Diabetes Self-Care Activities Measure - brief self-report questionnaire of diabetes self-managementGSCBS Generic Self-care Behaviours scale - examines the use of 6 recommended health care behavioursHEIQ Health Education Impact questionnaire (selected scales) - to monitor perceived impact and quality of health education programs
WSD QuestionnairesCognitive measuresSCB-SES Self-care Behaviours Self Efficacy Scale - examines individuals confidence in performing self-care behavioursGeneralised SES Generalised Self Efficacy Scale - assesses optimistic self- beliefs to cope with a variety of difficult demands in lifeSUTAQ Service User Technology Acceptability Questionnaire – technology users beliefs and perceptions of the equipment (e.g. impact of kit on communication, concerns with confidentiality, anxiety using kit)Illness Strain Measure of strain related to having a chronic illness –Index (revision of CGSI for cared for individual)Impact of Illness Measures the degree that illness/problems interferes withScale key roles and responsibilities in daily livingSubjective Measures the individual’s estimate of the social pressure toNorms perform or not perform the target behaviour
WSD QuestionnairesAdditional measuresICECAP ICEpop CAPability measure for Older people - for economic evaluation of health and social care interventionsASCOT Adult Social Care Outcomes Toolkit - social care related quality of life (selected items)CSRI Client Services Receipt Inventory - cost-related information about people with health problems for use in health service evaluations, calculates a total weekly cost of care packageSNAI Social Network Assessment Instrument – identifies participants social network typeCCA Carer’s confidence and anxiety when looking after othersCGSI Care-giver Strain Index - measuring strain related to care provision;
Themes 2 & 3 Number of Participants 700Intervention Control 617 Control Intervention 1399 1367 592 51% 49% 600 500 403 398 400 384 372 300 Newham, Cornwall, 801, 29% 756, 27% 200 100 Kent, 1209, 44% 0 Cornwall Kent Newham
Themes 2 & 3 Number of Participants 1000 Control Intervention 845 800 728 639TeleCare 600 1193 554 TeleHealth 43% 1573 57% 400 200 0 TeleHealth TeleCare
Theme 4THEME 4 OVERALL AIM OF EVALUATION THEME NO. PARTICIPANTS REQUIREDQualitative What are the service delivery 45 participants & arrangements and personal service user informal carersstudy. and professional long−term condition management prior to the introduction of the 15-30 non-participantsWhat are the schemes? How are these different andservice users, similar across the three participating sites? 75 health & social careinformal carers professionalsand health and What changes occur to establishedsocial care practices in order to adoptprofessionals’ telecare/telehealth (in terms of different professionals own work practices and theexperiences of overall division of labour?telehealth andtelecare? Does telecare/telehealth improve productivity of key professionals such as community matrons?
Theme 5THEME 5 OVERALL AIM OF EVALUATION NO. PARTICIPANTS THEME REQUIREDQualitative study of To assess how the whole system 45 key WSD managers working is perceived and enacted and commissioners inorganisational and how inter/intra organisational health & social servicesissues. contact and styles of collaboration change during the programme. It Staff from 3 WSDAN will also seek to understand how sitesWhat organisational professionals cope withfactors facilitate or organisational change and how theirimpede the roles and beliefs impact on the Staff from 3 non WSDsustainable adoption spread of innovation. It will look at related sitesand integration of how large scale change programmes influencetelehealth/telecare? organisational and individual professional identities.
The Evaluation Team Prof Stan Newman (Principal Investigator) Martin Cartwright, Prof Martin Knapp, Prof Ray Fitzpatrick, Shashi Hirani, Catherine Henderson, Dr Helen Doll, Lorna Rixon LSE University of Oxford Michelle Benyon City University Prof Anne Rogers, Prof James Barlow, Dr Peter Bower, Dr Jennifer Dixon, Dr Jane Hendy, Dr Caroline Sanders Dr Martin Bardsley Dr Richard Curry,National Primary Care research Dr Adam Steventon Tanaka Business School, & development centre, Nuffield Trust Imperial College London Manchester University Prof Chris Ham University of Birmingham (co-ordinator between Evaluation partners)