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Evaluation of the Scottish National Telecare Development Programme Findings and implications for future research


Findings and implications for future research. Sophie Beale ... Jen Kruger. Project Support Officer. Paul Trueman Director. Joint Improvement Team ... – PowerPoint PPT presentation

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Title: Evaluation of the Scottish National Telecare Development Programme Findings and implications for future research

Evaluation of the Scottish National Telecare
Development ProgrammeFindings and implications
for future research
  • Sophie Beale
  • Senior Consultant, York Health Economics
    Consortium, University of York
  • sjb29_at_york.ac.uk

  • What is Telecare?
  • Introduction to the Telecare Development
    Programme (TDP)
  • Overview of the evaluation of the TDP
  • Summary of the findings
  • Implications for the evaluation of telecare
  • Conclusions

Telecare Development Programme
  • Telecare Development Programme (TDP) launched in
    August 2006.
  • To help more people in Scotland live at home
    for longer, with safety and security, by
    promoting the use of telecare in Scotland,
    through the provision of a development fund and
    associated support
  • Supported by c8M in funding
  • Expected to provide a foundation for telecare to
    become an integral part of community care across

  • There is considerable variation in the way in
    which telecare, telehealth and telemedicine are
  • All involve the delivery of services via
    telecommunications and computerised systems,
    usually to individuals in their own home

Tele-intervention Examples
Telecare Telecare is concerned with monitoring over time to manage the risks (which may be the concern of health and/or social care) associated with independent living. Natural gas or bottled gas detector Wearable fall detector Passive Infra Red (PIR) movement detectors Nocturnal bed monitor Opening alerts for external doors.
Telehealth Remote exchange of physiological data between a patient at home and medical staff to assist in diagnosis and monitoring Blood pressure monitoring Blood glucose monitoring Cardiac arrhythmia monitoring and Medication reminder systems
Telemedicine Use of medical information exchanged from one site to another via electronic communications Remote consultations with specialists
Telecare Development Programme Specific
  • Reduce the number of avoidable emergency
    admissions and readmissions to hospital
  • Increase the speed of discharge from hospital
    once clinical need is met
  • Reduce the use of care homes
  • Improve the quality of life of users
  • Reduce the pressure on informal carers
  • Extend the range of people assisted by telecare
  • Achieve efficiencies (cash releasing/time
  • Support effective procurement.

Majority of these have important economic
implications for health and social care
Evaluation Overview
  • Joint Improvement Team commissioned an evaluation
    of the TDP
  • Assessment of the implementation and uptake
  • Assessment of performance against the agreed
  • Provide an evidence base on the costs and
    benefits of the Programme
  • Develop metrics that can become embedded in

Evaluation Methods
  • Multiple methods explored at the outset of the
  • Emphasise that the TDP was an investment
    programme, not a research exercise
  • Pragmatic approach
  • Work with existing routine data where possible
  • Minimise burden of data collection on
  • Fit-for-purpose study, acknowledging the

Evaluation Methods
  • Quarterly, self-reported monitoring from
    partnerships on progress and outcomes against
    pre-specified objectives
  • E.g. number of users, number of admissions
    avoided, number of delayed discharges avoided
  • Surveys of users and carers to understand their
  • Supplemented with case studies, including
    in-depth interviews with stakeholders, users and

Findings Welcome financial headlines!
  • Partnerships estimated to have saved over 11.5M
    as a result of the TDP investment
  • Reduction in admissions to care homes, equating
    to over 60,000 care home days c 31 of savings
  • Reduction in unplanned hospital admissions,
    equating to over 13,000 bed days c 30 of
  • Improved speed of discharge, equating to over
    5,000 bed days 16 of savings
  • TDP produced savings against 6 efficiency targets
    identified at the outset of the study

Findings Impact on Users and Carers
  • 60 of users reported improvements in quality of
  • Nearly 70 reported feeling more independent
  • Over 90 reported feeling safer
  • Less than 5 reported feeling lonelier as a
    result of telecare
  • Nearly 75 of informal carers felt that telecare
    had reduced pressure/stress
  • Facilitated greater independence for users

Findings Organisational Policy impact
  • Almost 8,000 new users of TDP funded telecare
    during 2007/08
  • Predominantly older people (85 aged gt65)
  • New users with dementia, learning disabilities or
    physical disabilities
  • Predominantly female (62)
  • Approximately half of partnerships used the
    National Framework Agreement to purchase telecare
  • Some partnerships found cheaper or better
    solutions outside of the National Framework

  • Impact is self-reported
  • Reliant on partnerships to consider the impact
    relative to no TDP grant.
  • Not possible to include a control arm - difficult
    to know the counter-factual
  • Not possible to attribute any incremental effect
    to TDP - some of the programmes were already
  • Incentives for partnerships to overstate the
  • In addition to this, caution should be taken in
    interpreting the financial outcomes
  • Some of the efficiency gains are unlikely to be

  • Partnerships took time to implement telecare
  • Not all partnerships were able to complete all
    quarterly returns over the course of the
  • Time-lag due to time involved in the purchase and
    implementation of telecare solutions
  • Additional time lag associated with the need for
    cultural change in users and professionals
    attitudes to care
  • E.g. referral triggers

  • Impossible to quantify displacement or unintended
    consequences of telecare
  • Are additional resources required in communities
    as a result of less reliance on secondary
    care/care homes?

What can we interpret from the findings?
  • Pragmatic study of telecare in use assessed
    against a wide range of outcome measures
  • Beneficial impact on health and social care
  • More importantly, beneficial impact on user
    outcomes, such as independent living and
    perceptions of safety
  • The study does not provide definitive evidence of
    the effectiveness of any specific intervention
  • Too many interventions included to assess
    effectiveness in any meaningful population

Implications for future research RCTs
  • Randomised controlled trials are the most
    appropriate means of assessing the effectiveness
    of individual interventions
  • Allow for identification of an attributable
    effect by controlling other influences
  • However, RCTs may be of limited value in
    supporting the mainstreaming of telecare
  • Effectiveness is context specific
  • Heterogeneity in users and service environments
  • Heterogeneity in access to interventions
  • Practical difficulties in recruitment and
  • Hawthorne effect observed in telehealth

Implications for future research
  • A number of alternative approaches to evaluation
    were explored
  • Before and after study
  • Monitor users before and after the introduction
    of telecare
  • Problematic in progressive conditions or where
    telecare has been provided after a sudden change
    in health state (e.g. stroke)
  • Use of predictive models
  • Predicts expected hospitalisations based on an
    individuals characteristics
  • Methods not fully mature problematic in
    progressive illnesses and focussed primarily on
    health care
  • Use of control groups
  • Difficulties in selecting control group what
    should you control for?
  • Is it ethical to refuse to provide telecare to a
    member of the control group?

Implications for telecare adoption
  • Widespread adoption of promising technologies
    remains limited due to the limited availability
    of high-quality evidence
  • Studies tend to be commissioned by those with an
    interest in promoting telecare
  • Small populations and lack of follow-up lead to
    limited generalisability of findings
  • Therefore, adoption of promising technologies
    remains limited

A model for pragmatic, evidence-based uptake of
  • A risk-sharing model may support appropriate
  • Purchasers and suppliers define reasonable
    objectives for telecare and evaluation criteria
  • Promising results support further adoption
  • Failure to achieve objectives explored
  • Rebates in place for sub-optimal performance?

A model for pragmatic, evidence-based uptake of
  • Risk-sharing is suited to promising technologies
    characterised by uncertainty over their
  • Addresses purchasers concerns about equivocal
    evidence base by providing some form of
  • Addresses manufacturers concerns about the need
    to continuously invest in context specific trials
  • Generates further evidence on the barriers and
    facilitators for implementation in practice
  • Increasingly applied to pharmaceuticals
    possibly more relevant to interventions such as
  • Hard endpoints available from routinely collected

Summary Recommendations
  • The Scottish TDP programme appears to have been a
    cost effective use of resources
  • Acknowledge the limitations of the pragmatic
  • Acknowledge that many of the benefits of the
    programme have yet to materialise
  • The TDP evaluation provides further evidence to
    support the mainstream use of telecare, although
    the findings are equivocal
  • Are RCTs the most appropriate means of supporting
    mainstreaming of telecare?
  • An evidence based approach to the staged
    widespread adoption of promising telecare
    technologies might address the concerns of all
    stakeholders involved.

  • Diana SandersonAssociate Senior Consultant
  • Jen KrugerProject Support Officer
  • Paul Trueman
  • Joint Improvement Team
  • TDP partnerships
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