Whole System Demonstrator Action Network Tim Ellis, Department of Health WSDAN, Integrated Care using Telecare and Telehealth, Birmingham March 2009

Whole System DemonstratorAction Network

Tim Ellis, Department of Health

WSDAN, Integrated Care using Telecare and Telehealth, Birmingham March 2009

Session Aims

• Reminder of WSD goals• Details of the implementation process -

Issues from the programme to date• Links to wider DH LTC Policy

Three WSD sites

• 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% 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

UA). Two areas already piloting telehealth Ashford / Shepway population of 211,100 & Dartford / Gravesham / Swanley population of 210,000

• 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 HF, COPD, Diabetes

KENT

WSD Evaluation

We want to know to what extent the WSD model of care:

• promotes individuals long term well-being and independence

• improves individuals and their carer’s quality of life• improves the working lives of staff• is more cost effective• is more clinically effective

Provide an evidence base for future care and technology models.

Large Scale

What we believe to be the largest randomised control trial of telehealth and telecare to date anywhere.

Up to 6000 usersReal timePragmatic

Cluster design based on practices (over 200 involved)

Multiple academic bodies involved in most complex DH Evaluation to date.

Process Implications

Practice Consent

DataSearch

Practice Letters & Follow Up

ConsentGained

EligibilityConfirmed

Baseline Interview

Assess if necessary

Install

Light Touch Visit

Ongoing data

collection

Interviewat

3 months

Patient goes live on trial

EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Randomisation

Organisational Readiness

RecruitEquip

Monitor

Mainstream vs Trial

Practice Consent

DataSearch


ConsentGained


Baseline Interview

Assess if necessary

Install

Light Touch Visit

Ongoing data

collection

Interviewat

3 months

Patient goes live

EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Randomisation


InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation


Build understanding – changing landscapeEnsure engagement – senior commitment

Governance – fit for purposeRecruitment - & retention

Defined roles & responsibilities - targetsSection 75s - funding

SSISAs – new partnersPathways - comms

Project Mgmt.RegularlyReinforce

Commitment(Visits)

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

Mainstream – incentiviseTrial – sell/encourage

PCT, PEC, LMC, CM, SN engagement.Demonstrations - champions.

Briefing materials/events.Evaluation/DH input

External support provided.MOU signed & returned.

Organisational Readiness Build over time.Targets change.

Champions.Drop.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Evaluators informed of practices signing-up to be involved in WSD programme.

Practices randomised into 4 groups.

Randomisation takes into account practice size, condition prevalence, deprivation etc.

Organisational Readiness Locality bias.Controls &

interventions may be out of steptemporarily


Practice Consent

Assess if necessary

DataSearch


ConsentGained


BaselineInterview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Mainstream – remote extractionTrial – practice visit

QOF criteria A searched – condition & severity.

Data cleansing/cross checksCriteria B searched – use of unplanned care.

GP/CM review of eligible list - Monitor

Organisational ReadinessNo crossover.

Use other sources:clinics, falls, memory,

case review, 3S,referral


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Mainstream – promote, opt outTrial – no promotion, opt in

Practice identify addresses & sent letters Wait - follow-up.

Provide Admin Support.Demographics.

Organisational ReadinessNo Response.Not interested.

Too ill.Not ill enough.

Stigma/reminder.Existing user.

Sheltered.Out of the country.

Language.Not their job.To onerous

Cohabit.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Practice & Social Care review all eligible people.

Practice staff identify exclusions.Practice notify evaluators of +ve

responses.(If last baseline readings not within 6

months then they should be taken again)

Organisational Readiness New demandBaseline COPD

Exclusions.Practice Variation.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Mainstream – optionalTrial – evaluation explained

Book, Visit & Brief.Check environment for installation.

Gain consent for installation.Seek consent for evaluation

interview.


Site and TeamVariation.

Core script.Training.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months

Patient goes live

EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Evaluation team contact willing individuals to arrange a date

for baseline interview.

Visit to conduct condition specific baseline interview.


2000Monitor feedback.

Retrain.Drop out.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

If not currently known to the service then arrange for a needs assessment - includes specialist assessment for

telehealth and telecare.

Agree case manager responsibility/pathways.

Update care plan.


Resource constraint.OOH.

Not fit for trial.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Arrange suitable date for installation.If necessary arrange for broadband

installation.

Install team visit and install appropriate equipment and provide training.

Record on asset register.


Supplier failure.Recall.OOH.

No Show.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months

Patient goes live

EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Training materials provided.

Answer any queries and requests for support. Monitor usage e.g.

increased anxiety.

Telephone support.


Existing Users.



Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months

Patient goes live

EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Review readings over a two week period.

Ensure thresholds set appropriately.

Ensure case manager aware of responsibilities.

Reading/MonitoringFrequency.


Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months

Patient goes live

EarlyMonitor

& Calibration

TrainingInterview

at12 months

80 Days


One blockageimpacts

flow throughout.



Practice Consent

Assess if necessary

DataSearch


ConsentGained


Baseline Interview

Light Touch Visit

Randomisation

InstallOngoing

data collection

Interviewat

3 months


EarlyMonitoring

& Calibration

TrainingInterview

at12 months

Further MORI interviews.

Pseudonymised data collection. Combined Model.

Parallel interviews with professionals, carers, organisational leads.

Combined Model – Perf. mgmt.

Drop out – move, RIP, condition

WSD Action Network Developing the lessons from the 3 WSD sites and the 12 WSDAN members

Croydon

Birmingham

Barnsley

Southampton

Nottingham

Leicester

Leeds

East Riding

Norfolk

Lincolnshire

Lancashire

[email protected]

mailto:[email protected]

Thank you

Documents

Whole System Demonstrator Action Network Tim Ellis, Department of Health WSDAN, Integrated Care using Telecare and Telehealth, Birmingham March 2009