Lessons from the REALITY telecare project and wider issues of service planning for longterm conditio

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Lessons from the REALITY telecare projectand
wider issues of service planning for long-term
conditions.

• Howard Leicester Abdul Roudsari
• Centre for Health Informatics.
• 27 May 2005.

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Overview
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1. Long-term conditions and the NHS

• Pyramid of long-term conditions

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Range of conditions
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Policy shifts and Derek Wanless

• The Fully Engaged Scenario
• Levels of public engagement in relation to their
  health are high life expectancy increases go
  beyond current forecasts, health status improves
  dramatically and people are confident in the
  health system and demand high quality care. The
  health service is responsive with high rates of
  technology uptake, particularly in relation to
  disease prevention. Use of resources is more
  efficient.

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2. Telecare and the REALITY approach
Source Department of Health
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REALITYs clinical sites
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The REALITY service
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Example clinical dataset diabetes
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European five dimensional QoL scale (EQ5D)
profile 5 dimensions with 3 similar response
categories.
2. Self-reported health status from 0-100 on an
analogue scale.
Worst imaginable

Best imaginable
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Analytical concepts by key stakeholders
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Data sources in addition to remotely monitored
datasets

• Forms for each patient at stages of service
  delivery
• 1. Baseline characteristics results of initial
  training.
• 2. Progress at clinical visits (landmark points)
  - including disease-specific QoL instruments.
• 3. Achievements by last clinical visit.
• 4. General reviews by staff patients.
• Additional forms
• 5. Site quality audits (resources and adherence
  to protocols).
• 6. Log of technical problems calls to
  helplines.  
• 7. Diary of clinical activities and costs over a
  representative period.
• Qualitative sources
• Staff and patient comments via official forms.
• Stakeholder pre/post study interviews.
• Site documentation reviews (wider policies and
  practices).

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Global service use at the London site
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Global service use at the Estonian site
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Blood glucose from a diabetic over 7 months
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Preliminary results individual QoL monitoring

• Variation in weekly self-reported health
  status by an individual with congestive heart
  failure.

• EQ5D profiles for the first and last week
  are, in fact, the same.

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3. Strategy, policy and local planning

• Strategy
• The overall process of deciding where we
  want to get to and how we are going to get there.
• Policy
• The means of moving in that direction. Often
  a number need to work together to deliver
  particular strategic outcomes.

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Using data to drive performance

• 
  Social/Health
• 
  Indicators
• Evaluation
  Data Analysis
• Implementation
  Useful Information
• Operations Planning
  Knowledge Management
• 
  
• 
  Strategy
  

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Information requirements

• Successful strategies are rarely achieved by
  spontaneous flashes of genius, but rather result
  from the systematic collection, analysis and
  evaluation of facts, circumstances, trends and
  opinions".
• Prime Ministers Strategy Unit

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Structuring the issues (systems thinking)

• "Underpinning strategic thinking is the ability
  and willingness to go back to first principles
  and challenge implicit assumptions. A fresh,
  objective evaluation of the situation may yield
  surprisingly different conclusions from the
  current status quo".
• "Keeping the big picture in mind, rather than
  being tempted by its complexity to focus
  attention on specific issues, is key to
  developing effective solutions. Systems thinking
  techniques can help to understand dynamically
  complex systems by mapping out how factors
  influence each other. This can be powerful for
  helping to establish a common view of the way the
  world works and when trying to anticipate the
  likely response to possible interventions".
• Prime Ministers Strategy Unit

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Note on multidisciplinary research

• "Multidisciplinary collaboration is a very
  fraught activity, and no one in their right minds
  should embark upon it without some compelling
  reason. Great personal as well as intellectual
  tensions can easily be generated by having to
  deal with people who don't even agree with you
  about how a problem is to be formulated, let
  alone how best to tackle it, and what counts as
  evidence. The matters that are taken for granted
  within one discipline are often the very things
  that constitute the controversial core of
  another".
• Prof Alan Williams
• Economist, York University
• Preface to book on EQ5D
• by the Consortium

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Conclusions

• Long-term conditions and the NHS.
• A numeric and human case. Complementary policy
  shifts.
• Telecare and the REALITY approach.
• Components identified.
• More research on implementation and integration.
• Strategy, policy and local planning.
• Quality information and systems thinking
  important.
• Truly multidisciplinary approach required.