Adam Steventon: Evaluating the Whole System Demonstrator trial
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share

Adam Steventon: Evaluating the Whole System Demonstrator trial

  • 136 views
Uploaded on

Adam Steventon: Evaluating the Whole System Demonstrator trial

Adam Steventon: Evaluating the Whole System Demonstrator trial

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
136
On Slideshare
136
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. © Nuffield TrustJune 22, 2012Adam Steventon: Evaluating the WholeSystem Demonstrator trialAuthors:Adam Steventon, Martin BardsleyNuffield Trust
  • 2. © Nuffield TrustWhat is telehealth?“the remote exchange of data between a patientand health care professionals as part of thediagnosis and management of health careconditions”Telehealth devices enable items such as bloodglucose level and weight to be measured by thepatient and transmitted to health care professionalsworking remotely.ImageisthecopyrightofTunstallGroupLtd© Nuffield Trust
  • 3. © Nuffield TrustThree whole system demonstrators• The poorest county in England, with adispersed rural population• Population of >500,000• 46% of the population live in settlements of<3,000 people• 99.1% White British• 10.3% of the population are aged 65+;7.2% 75+ and 2.6% 85+• 21% of the population report a limitinglong-term illnessCORNWALL• One of the most deprived areas in the UK• Population of 270,442 - GP registeredpopulation of 300,000• Population increasing at a higher rate thanthe London average• 2nd most diverse population in the UK ->68% black and minority ethnic (BME) >140first languages• 8.5% of the population are aged 65+• 17.3% of the population have a limiting long-term illness• Highest death rate from stroke and COPD• Highest diabetes rate in the UK• 2nd highest CHD rate in LondonNEWHAM• Combination of rural and urban populations• Population of 1.37m (excluding MedwayUnitary Authority). Two areas already pilotingtelehealth: Ashford/Shepway (population:211,100) and Dartford/Gravesham/Swanley(population: 210,00)• 3.5% BME• 17.3% of the population are aged 65+8.4% 75+ and 2.2% 85+• Within the target population, individualsreport having an average of 1.6 of the threetarget conditions of heart failure, COPD,diabetesKENT
  • 4. © Nuffield TrustTrial design
  • 5. © Nuffield TrustLong-term conditions of intervention participants
  • 6. © Nuffield TrustMulti-dimensional evaluationTheme 1(Nuffield Trust)Impact of serviceuse andassociated costsfor the NHS andsocial servicesAll 3,000 peopleTheme 2(City & Oxford)ParticipantreportedoutcomesSubset of peopleplus theirinformal carersTheme 3(LSE)Costs and cost-effectivenessSubset of peopleTheme 4(Manchester& Oxford)Experiences ofservice users,informal carersandprofessionalsQualitativeinterviewsTheme 5(Imperial)Organisationalfactors andsustainableadoption andintegrationQualitativeinterviews
  • 7. Information flows for this analysis
  • 8. © Nuffield TrustPredictive risk scores
  • 9. © Nuffield TrustCrude (unadjusted) trends in emergency hospital admissions
  • 10. © Nuffield TrustPrimary measure: Proportion of patients admittedto hospital in twelve months of trialControl Intervention AbsolutedifferenceRelativedifferenceProportion of patientsadmitted to hospital in 12months (%)48.2 42.9 -5.2 -10.8Endpoint Interpretation Model Estimate [95%confidenceinterval]p valueAdmission proportion Odds ratioUnadjusted0.82[0.70 to 0.97] 0.017Adjusted0.82[0.69 to 0.98] 0.026Combined Modeladjusted0.82[0.69 to 0.96] 0.016
  • 11. © Nuffield TrustDifferences in secondary measuresControl Intervention AbsolutedifferenceRelativedifferenceMortality (%) 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%= statistically significantKey:
  • 12. © Nuffield TrustKey findings• Compared to controls, a smaller proportion of intervention patients wereadmitted to hospital.• Intervention patients had fewer emergency admissions, deaths and hospitalbed days.• Tariff hospital costs £188 per head lower in intervention group – but this did notreach statistical significance. (Cost of intervention not included in thesefigures).• Some reasons for caution:• Theoretical possibility of differences in characteristics of intervention andcontrol patients• Differences in emergency hospital admissions were from a low base• Increases in emergency admissions for controls
  • 13. © Nuffield TrustMulti-dimensional evaluationTheme 1(Nuffield Trust)Impact of serviceuse andassociated costsfor the NHS andsocial servicesAll 3,000 peopleTheme 2(City & Oxford)ParticipantreportedoutcomesSubset of peopleplus theirinformal carersTheme 3(LSE)Costs and cost-effectivenessSubset of peopleTheme 4(Manchester& Oxford)Experiences ofservice users,informal carersandprofessionalsQualitativeinterviewsTheme 5(Imperial)Organisationalfactors andsustainableadoption andintegrationQualitativeinterviews
  • 14. © Nuffield TrustJune 22, 2012www.nuffieldtrust.org.ukSign-up for our newsletter:www.nuffieldtrust.org.uk/newsletterFollow us on Twitter: http://twitter.com/NuffieldTrust© Nuffield Trustadam.steventon@nuffieldtrust.org.uk