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Retrospective observational study of the impact on emergency admission of telehealth at scale delivered in community care in Liverpool, UK
  1. Cees van Berkel1,2,
  2. Peter Almond3,
  3. Carol Hughes3,
  4. Maurice Smith2,
  5. Dave Horsfield2,
  6. Helen Duckworth2
  1. 1 Philips Research Cambridge, Cambridge, UK
  2. 2 NHS Liverpool Clinical Commissioning Group, Liverpool, UK
  3. 3 Health Technology (Telehealth), Liverpool Community Health NHS Trust, Liverpool, UK
  1. Correspondence to Dr Cees van Berkel; cees.van.berkel{at}hotmail.co.uk

Abstract

Objective To assess the effect of a real world, ongoing telehealth service on the use of secondary healthcare.

Design A retrospective observational study with anonymous matched controls.

Setting Primary and community healthcare. Patients were recruited over 4 years in 89 general practices in Liverpool, UK and remotely managed by a dedicated clinical team in Liverpool Community Health.

Participants 5154 patients with chronic obstructive pulmonary disease, heart failure or diabetes were enrolled in the programme, of whom 3562 satisfied the inclusion criteria of this study.

Intervention At least 9 weeks of telehealth including vital sign collection, questionnaires, education, support and informal coaching by clinical staff.

Primary outcome Reduction in the number of emergency admissions in the 12 months after start, compared with the year before start. Secondary subgroup analysis to improve future targeting and personalisation of the service.

Result The average number of emergency admissions for the intervention group at baseline is 0.35, 95% CI 0.32 to 0.38. The differential decrease in emergency admissions in the intervention group in comparison with the control group, the average treatment effect, is 0.08, 95 CI 0.05 to 0.11, corresponding to an average percentage decrease of 22.7%. In subgroup analysis, a score is calculated that can be used prospectively to predict individual benefit from the intervention. Patients with an above median score (37%) are predicted average reduction in emergency admissions of 0.15, 95% CI 0.09 to 0.2, corresponding to a percentage decrease in admissions of 25.3%.

Conclusion The telehealth intervention has a positive impact across a wide cohort of patients with different diseases. Prospective scoring of patients and allocation to targeted telehealth interventions is likely to improve the effectiveness and efficiency of the service.

  • primary care
  • telemedicine
  • chronic airways disease
  • heart failure
  • diabetes & endocrinology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors have contributed to the work described in this paper, the preparation of the paper, drafting of relevant sections, revising it critically and final approval. They agree to be accountable for all aspects of the work. The authors have contributed in the following way. CvB: Statistical analysis and coordinating the preparation of the paper. PA: Project Management of the telehealth service, preparation of the intervention protocols. CH: Clinical Leadership for the telehealth hub, stakeholder management and patient champion. MS: Senior GP clinical leadership. As CCG board member responsible for the vision and objectives of the telehealth service. DH: Senior CCG programme management. Responsible for integrated and sustainable design and delivery. HD: CCG Intelligence Lead. Responsible for data quality and stewardship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data were processed under the legal mandate of the CCG and cannot be transferred to a 3rd party.

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