Shock as research reveals telehealth saves lives, but does not cut costs

22-Jun-2012

Review of Government telehealth trial reveals \'significant\' reduction in deaths, but no major financial efficiencies

The future commissioning of telehealth technologies could come down to an argument between reducing costs or cutting the number of deaths and serious illness, the findings of vital new research suggest.

Independent analysis of the Department of Health’s Whose System Demonstrator (WSD) telehealth trial by the Nuffield Trust has revealed a ‘significant’ impact on hospital admissions and mortality rates among patients using telehealth systems, but apparently no major impact on the cost of treatment.

This will come as a shock to many NHS trusts and local authorities who were banking on telehealth to help them make large-scale financial savings across patient pathways for a number of long-term conditions.

Many local NHS efficiency plans assume financial savings from investment in telehealth plus related support. The trial did not conclude there was a reduction in hospital costs due to telehealth

The report, the first of five peer-reviewed papers examining the impact of the WSD programme, the largest trial of telehealth and telecare in the world, states: “Many local NHS efficiency plans assume financial savings from investment in telehealth plus related support. The trial did not conclude there was a reduction in hospital costs due to telehealth. This does not mean telehealth does not have an impact on costs, only that the differences observed in this trial could have been the effect of chance, so commissioners will need to look carefully at this trial and consider whether it is necessary to refine their approach.

“Decisions made about introducing telehealth should also take account of the overall cost of the intervention - telehealth technology, plus monitoring and related care - the impact on quality of life for patients, and carer outcomes, as well as the experiences of patients and professionals.”

The WSD trial involved 3,230 people with diabetes, chronic obstructive pulmonary disorder and heart failure from 179 GP practices in Cornwall, Kent and the London Borough of Newham and was carried out between May 2008 and November 2009.

The Nuffield Trust paper, published this week in the British Medical Journal , examines the impact of the technology on mortality rates over 12 months and pre-specified secondary endpoints including the number of inpatient bed days, emergency admissions, elective admissions, outpatient attendances, and emergency department visits, as well as the notional cost of hospital activity to commissioners of care based on national tariff costs.

The findings compare outcomes for the ‘control’ group, who were not given telehealth technology, and the ‘intervention’ group, who did use the systems, which included blood glucose and haemoglobin oxygenation monitors. Readings from these were sent back to healthcare professionals working remotely, who were then able to act on any warning signs. They showed:

  • Mortality rates reduced by 45% with intervention patients ‘significantly’ less likely to die within 12 months than control patients. The findings show 4.6% of the intervention group died over a 12-month period, compared with 8.3% of control group, a difference of 60 patients
  • The proportion of patients admitted to hospital reduced by 11%. Telehealth patients had a lower hospital admission proportion than those without telehealth (odds ratio 0.82 vs 0.70) during the 12-month trial
  • Emergency admissions reduced by 20%: The mean number of emergency admissions was 0.54 per person in the intervention group compared to 0.68 in control group. This equates to 20.6% less emergency admissions for those people with telehealth
  • For intervention patients the cost of hospital care was £188 per patient less than those without telehealth

Given that funding for another large randomised controlled trial is unlikely in the near future, thought should be given as to how to advise local commissioners of low-cost local evaluations that are good enough to show the impact of telehealth if implemented

The report, based on research led by senior Nuffield Trust analyst, Adam Steventon, states: “The differences in emergency admissions and mortality were statistically significant so were unlikely to have been caused by chance.”

And it calls for further research to determine whether the improvements in patients’ health can be realised across the country, and whether there is any positive impact on cost.

It states: “Since the demonstrators were established, telehealth equipment, monitoring systems and cost models have all developed. Telehealth may demonstrate larger effects if targeted on patients with certain characteristics, such as those at higher risk of emergency hospital admission, though further work in necessary to determine whether this would be beneficial.

“To move forward appropriately there is a need to design interventions carefully, learning from this trial, and to monitor the impact. Given that funding for another large randomised controlled trial is unlikely in the near future, thought should be given as to how to advise local commissioners on low-cost local evaluations that are good enough to show the impact of telehealth if implemented, and the desirability of low-cost, near-real-time surveillance of the impact on service use and cost using nationally-available data.”

Industry must now work hard to deliver on the promise to enable millions more people to benefit from improved health and independence, working with our health, social care and housing partners to develop effective funding models to enable telehealth at scale

But,despite the surprise over the lack of savings seemingly achieved through the deployment of telehealth, the report has been widely welcomed.

Angela Single, chairman of the 3millionlives industry leadership group, which is the leading the Department of Health’s plan to roll out telehealth technology to three million patients in the UK following the WSD study, said: “The paper confirms a significant reduction in hospital admissions and mortality rates which, if scaled up across the UK, would bring major benefits to healthcare resources and patient outcomes.”

And she called for suppliers to do their bit to improve systems and make them more affordable for cash-strapped health and social care providers.

She added: “Industry must now work hard to deliver on the promise to enable millions more people to benefit from improved health and independence, working with our health, social care and housing partners to develop effective funding models to enable telehealth at scale.”

Gil Baldwin, chief executive of supplier, Tunstall Healthcare, and a spokesman for the 3millionlives campaign added: “Many NHS and social care organisations have already commenced large-scale roll outs of telehealthcare services. The findings from the study give further legitimacy, clinical assurance and, finally, the data set to back up these innovative approaches to transforming health and social care.”

And Simon Arnold, managing director of Tunstall Healthcare, added that the impact on patient outcomes should be seen as the most important reason for investing in the technology. “This paper confirms that telehealth significantly reduces deaths, helps patients to avoid the need for emergency hospital admissions, and shortens hospital stays when compared with traditional approaches to care,” He said. “This is absolutely complementary to our work with partners across the UK and provides an indisputable evidence base for clinicians and commissioners when making decisions about patient care in the future.”

Responding to concerns about cost, he said: “Tunstall currently has 90 telehealth programmes running in the UK, with a growing number based on a per-use cost model for each patient, minimising upfront cost and accelerating delivery of benefits, both to patients and the healthcare organisations.”

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To read the Nuffield Trust report in full, click here

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