Prof Ala Szczepura 1,2 Prof Christopher James 3 Workshop on prevention and detection (1-2pm) Digital Health: design, develop, deploy, evaluate Radcliffe House Warwick, University of Warwick 25 July 2013 1 Hon Professor, Warwick Medical School, University of Warwick, UK 2 Professor Health Technology Assessment, University of Coventry, UK 3 Institute of Digital Healthcare, University of Warwick, Coventry, UK USEFIL Project: Evaluation of technology in healthcare
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USEFIL Project: Evaluation of technology in healthcare · • Formal/ informal carer: ... Changing family structures mean in Europe one third ... • Promote socialisation and stimulate
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Prof Ala Szczepura1,2
Prof Christopher James3 Workshop on prevention and detection (1-2pm)
Digital Health: design, develop, deploy, evaluate Radcliffe House Warwick,
University of Warwick
25 July 2013
1 Hon Professor, Warwick Medical School, University of Warwick, UK 2 Professor Health Technology Assessment, University of Coventry, UK 3 Institute of Digital Healthcare, University of Warwick, Coventry, UK
USEFIL Project: Evaluation of technology in healthcare
Aims:
To use "off-the-shelf" technology to develop unobtrusive, low cost support systems for older people living alone.
• Older person: to enable the individual to maintain their independence and daily activities. Provide services
more adaptable to individual needs and preferences (personalization).
• Formal/ informal carer: to provide effective means of delivering support & accessing care.
• Health funder: to extend the time older people can live independently at home, limiting public expenditure and
providing cost-effective care.
Partners: 1. Institute of Digital Healthcare & Medical School, University of Warwick, UK
2. National Center for Scientific Research "Demokritos", Athens, Greece (lead)
3. VTT Technical Research Centre of Finland, Espoo, Finland
4. Center for Computing Technologies, University of Bremen, Germany
5. Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Greece
6. Fraunhofer Institute for Telecommunications, Munich, Germany
“enables people to realize their potential for physical, mental and social well being ….and to participate in society according to their needs, desires & capacity
while providing them with adequate protection, security and care when they require assistance”
- World Health Organisation, 2002
Active Ageing….
Challenge: Active Ageing
Active Ageing
Increasing Dependency
Number of people aged 75+ projected to nearly
double by 2033 - from 4.8 to 8.7 million in England
900,000 older people with high level of physical need
in 2002, will increase by 50% in next 20 years
500,000 centenarians predicted in UK by 2066
Historically, most care for older people provided at
home with support of family
Changing family structures mean in Europe one third
of older people living at home are now alone
DH says at least 3 million people in UK with long term
conditions and/or social care needs could benefit from
use of telehealth/ telecare services
Older Person’s Care & Support Network
Older Person
at Home
Primary Care
Team
Domiciliary Care Community
Specialists
(e.g. Geriatrician,
Pharmacist)
NHS Community
Nursing Staff Informal Carer/ Relative
Quality of Life
Hospital Staff
(Inpatient care
A&E)
Need to build a USEFIL system to suit the older person living alone at home….
....not just providers of health & social care
Telecare: What way forward?
• Review of reviews: real-time telecare can improve health outcomes through enhanced
disease monitoring & better communication with health care professionals*
• Telecare demonstrator programme (Cornwall) for patients discharged home shows 20%
fall in emergency admissions & 45% fall in mortality over 1 year**
• January 2012 - NHS care service minister announces aim to develop telehealth/telecare
services to support people with long-term conditions
* Deshpande A, Khoja S, McKibbon A, Jadad AR: Real-Time (Synchronous) Telehealth in Primary Care:Systematic Review of Systematic Reviews [Technology ** Department of Health. Whole system demonstrator programme: Headline findings - December 2011. 2011 ;
Need to consider: Value for money
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
1970 1975 1980 1985 1990 1995 2000 2005
Per
Capita S
pendin
g -
PPP A
dju
sted
Growth in Total Health Expenditure Per Capita, U.S. and Selected Countries, 1970-2008
United States
Switzerland
Canada
OECD Average
Sweden
United Kingdom
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted. Break in series: CAN(1995); SWE(1993, 2001); SWI(1995); UK (1997). Numbers are PPP adjusted. Estimates for Canada and Switzerland in 2008.
Care Homes Academic Research Team (CHART)
Challenges: What way forward?
Personal health portals Online engagement tool to connect patients with healthcare providers, families, social services & care givers.
Unobtrusive activity monitoring Wearable devices to unobtrusively and reliably extract cardiac and motion related features.
Home clinical monitoring for oncology patients Patients regularly monitor white blood cell count, temperature & other symptoms. Results used to inform timing of further chemotherapy or intervention
Range of technology support…….
Employment and skills in the social care sector
Improving productivity in labour intensive services whilst maintaining quality
Increasing capital-labour ratio Role for new technology
beyond “tele-care”
also
“attracting boys into girls jobs”
Improving employee skills Time for training staff & managers
improving occupation’s status
the feeding
robot
the keeping
company
robot
Hospital admission/ discharge Optimal preparation of patients & follow up at home
Personalised services Deliver appropriate level of health & social care for older person at home
Self-management Actively develop older person’s knowledge, motivation and skills
Up to 40% of acute hospital beds filled with people who shouldn’t be there, mostly elderly.
25% of emergency admissions linked to elderly patients with chronic diseases,
at an estimated excess cost of £2bn. p.a.
Key Challenges: Active Ageing
Coordination of care Across patients’ various conditions and different care givers
USEFIL Support for Older Person
Important issues for evaluation….
• question of choices in the use of health care resources such as:
– what technologies to provide, when and at what level?
– how and where to provide such technologies?
– who should get the technologies?
• these are important questions for those who provide health care (e.g. clinicians), those who plan care provision or purchase care (e.g. Third Party Payers), as well as those who develop new technologies (e.g. scientists)
USEFIL Validation & Evaluation Trial
(Frail Elderly)
Technology as a facilitator for older people largely confined to home:
- Citizen-centred care
citizen empowerment
preventive care & early diagnosis/alerts
disease management
independent living for ageing society
• USEFIL Ethical Management
– to ensure all USEFIL research is carried out under best ethical guidelines
(m36)
October 2014
(m31)
May 2014
Commence Ethical
Applications
(m19)
May 2013
Decide on
distribution of
Technologies
(m14)
January 2013
USEFIL Validation and Evaluation (Pilot Trials)
- UK (frail elderly), Israel (stroke), Greece (mental health)
Ideal Scope of Evaluation
Process measures – usage, acceptability
Outcome measures - physical, psychological, social
Value for Money
7 Levels of Telecare Evaluation: Adapted from Szczepura & Kankaanpää (1996)
• Level 1: Technical : Does the telecare perform reliably and deliver
reproducible data?
• Level 2: Diagnostic accuracy: Does the data enable an accurate diagnosis to be
made of the situation?
• Level 3: Usability: Is the technology acceptable to patients & carers,
do they use it appropriately?
• Level 4: Treatment impact: Does the information provided influence selection and
delivery of treatment/ care?
• Level 5: Patient outcome: Does the technology contribute to improved health
of the person/patient?
• Level 6: Cost-effectiveness: Does use of telecare improve cost-effectiveness
of care delivery?
• Level 7: Social/organisational/ Does the technology have any social, legal, ethical
ethical/legal: or organisational implications?
Outcome indicator checklist
7 elements to address
Developing outcome indicators
Objective What are we trying to measure? 1. Why are we collecting this information? Be specific
Methodology
How to capture the data 1. What data needs to be captured
2. Who (or what) to capture the data
3. How often to capture the data
4. Is it achievable (time, resources, revenue)?
Limits Can we preset levels for:
1. Acceptable, Concern, Unacceptable, Critical
Presentation Graphic or Text
Interpretation 1. What does it mean?
2. Does it reflect on KEY quality/ outcome measures?
3. Can we compare it?
4. Can we trend it?
Limitations 1. Unintended variables
2. What does it not mean?
Action Plan 1. What will we do if it indicates acceptable outcomes?
2. What will we do if it does not?
Nonsense Metrics
[urine culture] * [glucose] * [INR]
[NUPA hr] * [Telephone minutes] X100
Just because you can calculate a
value, doesn’t mean that you should.
“Health is a state of complete physical, mental and social well being and not merely the
absence of disease or infirmity”
- World Health Organisation, 1948
Health-related quality of life - key outcome
What could USEFIL system provide?
From Perspective of Frail Older Person Living Alone:
• Increase sense of safety through unobtrusive monitoring
• Detect life-threatening situations and alert/ inform carers
• Promote socialisation and stimulate activities which
improve quality of life and reduce feelings of isolation
• Provide entertainment & educational activities leading to a
more active profile
• Enable individual to remain in own home with adequate
protection, security and care when they require assistance
(WHO Active Ageing)
UK Trial: Planned outcome measures for…
• Older Person • ICECAP-O Instrument: to measure capability for older people. The instrument contains five
attributes (attachment, role, enjoyment, security and control), each with four levels. UK index
values for ICECAP-O are available; developed for economic evaluation.
• ASCOT INT4: to capture information on social care-related quality of life (SCRQoL). Allows
current and expected SCRQoL to be estimated in community settings.
• Modified Barthel Index: to measure activities of daily living (ADL) in terms of: personal hygiene,