Adam Steventon: Evaluating the Whole System Demonstrator trial Authors: Adam Steventon, Martin Bardsley Nuffield TrustJune...
What is telehealth?  “the remote exchange of data between a patient  and health care professionals as part of the  diagnos...
Three whole system demonstrators             CORNWALL                                           NEWHAM                    ...
Trial design               © Nuffield Trust
Long-term conditions of intervention participants                                                    © Nuffield Trust
Multi-dimensional evaluation   Theme 1             Theme 2            Theme 3            Theme 4          Theme 5 (Nuffiel...
Information flows for this analysis
Predictive risk scores                         © Nuffield Trust
Crude (unadjusted) trends in emergency hospitaladmissions                                                  © Nuffield Trust
Primary measure: Proportion of patients admittedto hospital in twelve months of trial                              Control...
Differences in secondary measures                                          Control     Intervention    Absolute      Relat...
Key findings• Compared to controls, a smaller proportion of intervention patients were  admitted to hospital.• Interventio...
Multi-dimensional evaluation   Theme 1             Theme 2            Theme 3            Theme 4          Theme 5 (Nuffiel...
www.nuffieldtrust.org.uk         Sign-up for our newsletter:         www.nuffieldtrust.org.uk/newsletter         Follow us...
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Adam Steventon: Evaluating the Whole System Demonstrator trial

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In this audio slideshow, Adam Steventon, Senior Research Analyst at the Nuffield Trust, provides an introduction to the Department of Health’s Whole System Demonstrator trial – to date, the largest and most complex evaluation of telehealth in the world.

The Nuffield Trust led on one of five strands of analysis to examine the impact of telehealth on trial participants’ use of hospital care and on their mortality. Here, Adam summarises the key findings from this study.

The full findings have been published in the British Medical Journal (BMJ) and are summarised in the Nuffield Trust report: 'The impact of telehealth on use of hospital care and mortality' (June 2012), by Adam Steventon and Martin Bardsley.

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Adam Steventon: Evaluating the Whole System Demonstrator trial

  1. 1. Adam Steventon: Evaluating the Whole System Demonstrator trial Authors: Adam Steventon, Martin Bardsley Nuffield TrustJune 22, 2012 © Nuffield Trust
  2. 2. What is telehealth? “the remote exchange of data between a patient and health care professionals as part of the diagnosis and management of health care conditions” Telehealth devices enable items such as blood glucose level and weight to be measured by the patient and transmitted to health care professionals Image is the copyright of Tunstall Group Ltd working remotely. © Nuffield Trust © Nuffield Trust
  3. 3. Three whole system demonstrators CORNWALL NEWHAM KENT • One of the most deprived areas in the UK • Combination of rural and urban populations • Population of 270,442 - GP registered • Population of 1.37m (excluding Medway• The poorest county in England, with a population of 300,000 Unitary Authority). Two areas already dispersed rural population • Population increasing at a higher rate than piloting telehealth: Ashford/Shepway• Population of >500,000 the London average (population: 211,100) and• 46% of the population live in settlements of • 2nd most diverse population in the UK - Dartford/Gravesham/Swanley (population: <3,000 people >68% black and minority ethnic (BME) >140 210,00)• 99.1% White British first languages • 3.5% BME• 10.3% of the population are aged 65+; • 8.5% of the population are aged 65+ • 17.3% of the population are aged 65+ 7.2% 75+ and 2.6% 85+ • 17.3% of the population have a limiting long- 8.4% 75+ and 2.2% 85+• 21% of the population report a limiting term illness • Within the target population, individuals long-term illness • Highest death rate from stroke and COPD report having an average of 1.6 of the three • Highest diabetes rate in the UK target conditions of heart failure, COPD, • 2nd highest CHD rate in London diabetes © Nuffield Trust
  4. 4. Trial design © Nuffield Trust
  5. 5. Long-term conditions of intervention participants © Nuffield Trust
  6. 6. Multi-dimensional evaluation Theme 1 Theme 2 Theme 3 Theme 4 Theme 5 (Nuffield Trust) (City & Oxford) (LSE) (Manchester (Imperial) & Oxford)Impact of service Participant Costs and cost- Experiences of Organisational use and reported effectiveness service users, factors andassociated costs outcomes informal carers sustainable for the NHS and and adoption and social services professionals integrationAll 3,000 people Subset of people Subset of people Qualitative Qualitative plus their interviews interviews informal carers © Nuffield Trust
  7. 7. Information flows for this analysis
  8. 8. Predictive risk scores © Nuffield Trust
  9. 9. Crude (unadjusted) trends in emergency hospitaladmissions © Nuffield Trust
  10. 10. Primary measure: Proportion of patients admittedto hospital in twelve months of trial Control Intervention Absolute Relative difference difference Proportion of patients 48.2 42.9 -5.2 -10.8 admitted to hospital in 12 months (%) Endpoint Interpretation Model Estimate [95% p value confidence interval] Admission proportion Odds ratio 0.82 Unadjusted [0.70 to 0.97] 0.017 0.82 Adjusted [0.69 to 0.98] 0.026 0.82 Combined Model adjusted [0.69 to 0.96] 0.016 © Nuffield Trust
  11. 11. Differences in secondary measures Control Intervention Absolute Relative difference difference Mortality (%) 8.3 4.6 -3.7 -44.5% Emergency admissions per head 0.68 0.54 -0.14 -20.6% Elective admissions per head 0.49 0.42 -0.07 -14.3% Outpatient attendances per head 4.68 4.76 0.08 1.7% Accident and Emergency visits per head 0.75 0.64 -0.11 -14.7% Bed days per head 5.68 4.87 -0.81 -14.3% Tariff costs (£) 2,448 2,260 188 -7.7%Key: = statistically significant © Nuffield Trust
  12. 12. Key findings• Compared to controls, a smaller proportion of intervention patients were admitted to hospital.• Intervention patients had fewer emergency admissions, deaths and hospital bed days.• Tariff hospital costs £188 per head lower in intervention group – but this did not reach statistical significance. (Cost of intervention not included in these figures).• Some reasons for caution: • Theoretical possibility of differences in characteristics of intervention and control patients • Differences in emergency hospital admissions were from a low base • Increases in emergency admissions for controls © Nuffield Trust
  13. 13. Multi-dimensional evaluation Theme 1 Theme 2 Theme 3 Theme 4 Theme 5 (Nuffield Trust) (City & Oxford) (LSE) (Manchester (Imperial) & Oxford)Impact of service Participant Costs and cost- Experiences of Organisational use and reported effectiveness service users, factors andassociated costs outcomes informal carers sustainable for the NHS and and adoption and social services professionals integrationAll 3,000 people Subset of people Subset of people Qualitative Qualitative plus their interviews interviews informal carers © Nuffield Trust
  14. 14. www.nuffieldtrust.org.uk Sign-up for our newsletter: www.nuffieldtrust.org.uk/newsletter Follow us on Twitter: http://twitter.com/NuffieldTrust adam.steventon@nuffieldtrust.org.ukJune 22, 2012 © Nuffield Trust

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