The Whole System Demonstrator trial evaluated the use of telehealth technologies in three sites across England. Telehealth allows patients to monitor health data like blood glucose and weight at home and transmit it to healthcare professionals. The trial found that patients in the telehealth intervention group had lower rates of emergency hospital admissions, mortality, and bed days than the control group. While costs were lower for the intervention group, the difference was not statistically significant when factoring in the cost of the telehealth program. A multi-dimensional evaluation assessed patient outcomes, cost-effectiveness, experiences, and factors supporting adoption and integration into care systems.

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

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. 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. Trial design
© Nuffield Trust

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

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 and
associated costs outcomes informal carers sustainable
for the NHS and and adoption and
social services professionals integration
All 3,000 people Subset of people Subset of people Qualitative Qualitative
plus their interviews interviews
informal carers
© Nuffield Trust

7. Information flows for this analysis

8. Predictive risk scores
© Nuffield Trust

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

10. Primary measure: Proportion of patients admitted
to 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. 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. 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. 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 and
associated costs outcomes informal carers sustainable
for the NHS and and adoption and
social services professionals integration
All 3,000 people Subset of people Subset of people Qualitative Qualitative
plus their interviews interviews
informal carers
© Nuffield Trust

14. www.nuffieldtrust.org.uk
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June 22, 2012 © Nuffield Trust