1. © Nuffield Trust June 22, 2012 Adam Steventon: Evaluating the Whole System Demonstrator trial Authors: Adam Steventon, Martin Bardsley Nuffield Trust

2. © Nuffield Trust 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 working remotely. Image is the copyright of Tunstall Group Ltd © Nuffield Trust

3. Three whole system demonstrators The poorest county in England, with a dispersed 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 limiting long-term illness CORNWALL One of the most deprived areas in the UK Population of 270,442 - GP registered population of 300,000 Population increasing at a higher rate than the London average 2nd most diverse population in the UK - >68% black and minority ethnic (BME) >140 first 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 London NEWHAM Combination of rural and urban populations Population of 1.37m (excluding Medway Unitary Authority). Two areas already piloting telehealth: 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, individuals report having an average of 1.6 of the three target conditions of heart failure, COPD, diabetes KENT

4. © Nuffield Trust Trial design

5. © Nuffield Trust Long-term conditions of intervention participants

6. © Nuffield Trust Multi-dimensional evaluation Theme 1 (Nuffield Trust) Impact of service use and associated costs for the NHS and social services All 3,000 people Theme 2 (City & Oxford) Participant reported outcomes Subset of people plus their informal carers Theme 3 (LSE) Costs and cost- effectiveness Subset of people Theme 4 (Manchester & Oxford) Experiences of service users, informal carers and professionals Qualitative interviews Theme 5 (Imperial) Organisational factors and sustainable adoption and integration Qualitative interviews

7. Information flows for this analysis

8. © Nuffield Trust Predictive risk scores

9. © Nuffield Trust Crude (unadjusted) trends in emergency hospital admissions

10. © Nuffield Trust Primary measure: Proportion of patients admitted to hospital in twelve months of trial ControlIntervention Absolute difference Relative difference Proportion of patients admitted to hospital in 12 months (%) 48.242.9-5.2-10.8 EndpointInterpretationModelEstimate [95% confidence interval] p value Admission proportionOdds ratio Unadjusted 0.82 [0.70 to 0.97] 0.017 Adjusted 0.82 [0.69 to 0.98] 0.026 Combined Model adjusted 0.82 [0.69 to 0.96] 0.016

11. © Nuffield Trust Differences in secondary measures ControlIntervention Absolute difference Relative difference Mortality (%)8.34.6-3.7-44.5% Emergency admissions per head0.680.54-0.14-20.6% Elective admissions per head0.490.42-0.07-14.3% Outpatient attendances per head4.684.760.081.7% Accident and Emergency visits per head0.750.64-0.11-14.7% Bed days per head5.684.87-0.81-14.3% Tariff costs (£)2,4482,260188-7.7% = statistically significantKey:

12. © Nuffield Trust 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

13. © Nuffield Trust Multi-dimensional evaluation Theme 1 (Nuffield Trust) Impact of service use and associated costs for the NHS and social services All 3,000 people Theme 2 (City & Oxford) Participant reported outcomes Subset of people plus their informal carers Theme 3 (LSE) Costs and cost- effectiveness Subset of people Theme 4 (Manchester & Oxford) Experiences of service users, informal carers and professionals Qualitative interviews Theme 5 (Imperial) Organisational factors and sustainable adoption and integration Qualitative interviews

14. © Nuffield Trust June 22, 2012 www.nuffieldtrust.org.uk Sign-up for our newsletter: www.nuffieldtrust.org.uk/newsletter Follow us on Twitter: http://twitter.com/NuffieldTrust © Nuffield Trust adam.steventon@nuffieldtrust.org.uk