1. Effect of telehealth and telemonitoring
alerts on service use in routine practice
in England
Xavier Chitnis
Adam Steventon
Elizabeth Fisher
Martin Bardsley
05 October 2012 © Nuffield Trust

2. Background
• Growing interest in the use of telehealth to help manage long-
term health conditions
• Although some trials have produced encouraging results, the
impact of telehealth has not been robustly assessed in
routine settings
• This study aims to quantify the impact of a large routine
deployment of telehealth in North Yorkshire on the use of
primary and secondary health care
• Develop methods for routine monitoring of community-based
interventions aiming to reduce hospital use
© Nuffield Trust

3. Methods – study details
• North Yorkshire telehealth intervention began September
2009
• Tunstall “icp mymedic” system
• Eligibility criteria included history of heart failure, COPD or
diabetes
• Evaluation will include people recruited September 2009 –
June 2013 (N=753, powered to detect 20% change in
primary endpoint)
• 4 interim reports to be provided during project
© Nuffield Trust

4. Method - endpoints
• Primary endpoint - time to emergency admission or death
• Secondary endpoints - mortality and rates of general practice
and hospital use, & secondary care costs
• The impacts of telemonitoring alerts on rates of service use
will also be assessed separately to the overall impact of
telehealth
• Compare to retrospectively selected controls – 2 groups
• Local
• National
© Nuffield Trust

5. Matching - characteristics
© Nuffield Trust

6. Matching – hospital use
© Nuffield Trust

7. Methods – telemonitoring alerts
• Analysis of impact of alerts
• Blood pressure
• Oxygen levels
• Weight
• Peak flow
• Blood glucose
• Regression discontinuity design – rates of service use
following readings just above/below alert threshold
© Nuffield Trust

8. Summary
• Address gaps in existing telehealth evidence base
• Impact on primary care usage
• Changes in service use linked to telemonitoring alerts
• Routine practice rather than trial setting
• Aim to develop method for routine evaluation of community-
based interventions
© Nuffield Trust

9. www.nuffieldtrust.org.uk
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05 October 2012 © Nuffield Trust