The MOST project How have we changed the business model? 12 December 2012 Andrew McIntosh, Tunstall Healthcare Adam Steventon, Nuffield Trust

MOST Model for Optimising Scalable Telehealthcare is a collaboration between Tunstall Healthcare, NHS North Yorkshire, Ernst & Young and Nuffield Trust and part funded by the Technology Strategy Board's ALIP program. The 2 year project will deliver a service building toolkit and demonstrate the deployment of new product solutions that enable the up scaling of telehealth services

2015 >100k patients using telehealth as part of their LTC care. We explain the impact the toolkit made in improving service rollout, why each of the new product solutions was seen to be necessary back in 2012 and where each of these new components contributes to the overall provision of care. We look at how the impact of telehealth on secondary care services was evaluated.

UK population: 61,383k 18.7m patients in UK with telehealth applicable LTCs Long Term Conditions in the UK ,000 patients using telehealth (COPD, CHF, Diabetes)

UK population: 61,383k 18.7m patients in UK with telehealth applicable LTCs Long Term Conditions in the UK 2015 >100k patients using telehealth (COPD, CHF, Diabetes and other conditions)

The MOST toolkit Tools to support the development of new services –Programme governance –Planning and programme delivery –Engagement –Service / pathway re-design –Monitoring performance –Quality and safety –Communications –Piloting –Evaluation –Building a sustained increase in uptake –On going product and service development

The aim here was to identify –which new groups of patients could benefit from telehealth. –the product / service requirements for those patients and the stakeholders in their care –and the business case that would achieve a successful service proposition. We selected two areas where there were gaps in the 2012 service and several new product solutions that could be applied. Solutions

Enhancement of the diabetes telehealth service. Extension of the service into nursing and residential care homes The incorporation of mobility in a safe and manageable way. The incorporation of patient portals that complete the continuum of feedback and more completely address the requirements for supported self care

Diabetes Telehealth In 2012, diabetes was underserved by telehealth. MOST explored the reasons and developed a service definition which more fully supported patients needs at different stages in their condition. Mobile telehealth and patient portal were important components in the solution. In 2015

Nursing and residential care homes In 2012 a disproportionate number of A&E and unscheduled Hospital visits came from nursing and care homes. MOST demonstrated in a pilot how telehealth could be used in this environment to support the management of long term conditions and other conditions resulting in a 20% reduction in admissions from homes.

Patient Portals MOST deployed a patient portal in a large scale pilot and demonstrated how this enhanced telehealth for patients by giving online feedback, support and information for self management. In 2015 the majority of patients using telehealth or their informal carers use a patient portal

Mobile telehealth MOST explored how smartphones could be used safely and securely as a personal device for telehealth integrated with a telehealth programme. In % of telehealth patients use their smartphone to interact with their telehealth service.

© Nuffield Trust Scope of the evaluation Examine impacts of existing telehealth services on use of primary and secondary care and mortality Unscheduled hospital admissions Elective hospital admissions Hospital bed day use Outpatient attendances General practice consultations Tariff costs of hospital care Mortality Developing an approach using routine data and two methods Regular feedback of findings to North Yorkshire

© Nuffield Trust Example of the data sets collected March 2011

© Nuffield Trust Regression to the mean March 2011 Average number of emergency bed days

© Nuffield Trust Potential evaluation approaches – matched controls

© Nuffield Trust Potential evaluation approaches – regression discontinuity Vital signs reading from telehealth device (e.g. blood glucose level) Average emergency hospital admissions per head

© Nuffield Trust Vital signs reading from telehealth device (e.g. blood glucose level) Average emergency hospital admissions per head Threshold Potential evaluation approaches – regression discontinuity

© Nuffield Trust Vital signs reading from telehealth device (e.g. blood glucose level) Average emergency hospital admissions per head Threshold Observed discontinuity, attributed to telehealth Potential evaluation approaches – regression discontinuity

© Nuffield Trust Progress to date Evaluation methods and data flows have been agreed New telehealth patients are being linked to hospital data each quarter GP extractions expected early next year Final analysis expected December 2013