[Milton Keynes, UK/ Implementations] - A telehealth and telecare project implemented jointly by Milton Keynes health and social care services has resulted in improved quality of life for COPD patients, reduced hospital admissions, reduced visits to GPs and a long-term socioeconomic return of 28%.
The Milton Keynes project is part of the EU co-funded CommonWell project, which aims to overcome the communication gaps that separate health and social care service provision. Ten partners working in four member states — Milton Keynes in England, Bielefeld in Germany, Andalucia in Spain, Veldhoven in the Netherlands — co-operated to develop integrated service delivery to better support older people and those with long-term conditions.
Improving lives for COPD patients
In Milton Keynes, the council′s telecare service worked in partnership with Milton Keynes Hospital NHS Foundation Trust and the Community Nursing Service to improve the care of COPD patients by setting up an integrated telehealth and telecare service. The new service took a year to develop and implement and has completed a year-long pilot phase. The service was delivered to COPD patients discharged from hospital with a specially designed discharge pathway and referral from community nursing teams.
In the pilot, over 100 patients were provided with a home telecare unit, which allowed them to raise an alert at a monitoring centre and talk to trained operators who could action an appropriate response. The patients were also given equipment to measure their vital signs and upload data to the monitoring centre (taking about 10 minutes a day), where the relevant clinician could be notified if necessary. The clinicians could then take prompt action to stabilise the patient′s condition and avoid unplanned episodes of care, such as hospital admission.
Costs and benefits
Detailed analysis was made of the costs and benefits of the project for the service providers and users projected over seven years:
Key service costs
- Development of the service, defining clinical response protocols and staff training;
- technical setup of the call centre for telecare and telehealth;
- telecare and telehealth end-user devices; and
- daily triaging of telehealth readings by community matrons.
Key service benefits
- Improved quality of life and reassurance for patients;
- reduced number of admissions into hospital and visits to the GP;
- reduced time and travel cost spent for GP visits and hospital stays for patients; and
- more efficient delivery of the service due to easier follow-up to missed telehealth readings.
Key success factors
- Commitment of service providers, care professionals and other stakeholders involved to engage in implementation and operation of an integrated service;
- timely detection of exacerbations leading to hospital admission avoidance as main financial benefit for service providers; and
- mechanism to share investment cost, operational cost and operational savings between health and social care providers.
The cost of the service was made up from staff costs (59% for one healthcare staff and 0.7 FTE social care staff), equipment and software for the call centre and patients (39%), and set up costs (2%). It was estimated that the service would achieve a positive socioeconomic return about three years after operation started — including one year to develop and implement the service — and the average return for the service providers over seven years would be 28%.
The most substantial benefit came from the avoidance of hospital admissions and GP visits that were achieved by means of round-the-clock service availability. This allowed clinicians to recognise the decreasing health status of patients (eg due to developing infections) at an early stage and to intervene in time (eg by means of medication administration or adjustment) before a stay in hospital or a visit to the GP became necessary. Clinicians estimated that 168 hospital admissions and 85 GP visits were avoided by the 108 patients enrolled in the service over one year. Based on assumed average costs of £2,000 per admission and £50 per visit, it is estimated that about £340,250 was saved.
Sandra Rankin, Head of Service at Milton Keynes, said, “We are starting to join up information from different systems in order to get a more holistic view of the person and tailor the support on offer. A health and social care system that talks to each other enables us to give a much better response to needs. It also means the district nurses and community matrons can prioritise their workloads more easily, because they have extra information about patients from the telecare equipment. The integrated system also avoids wasted home visits as health professionals can easily see on the system if, for example, a patient has been taken into hospital.”[hw]
The CommonWell project website
Service costs and benefits of the four CommonWell pilot project sites
Economic assessment of the Milton Keynes pilot project
CommonWell Guidelines for Service Provision. The project has developed guidelines for decision makers to implement ICT-enabled integrated care solutions based on the experiences from the pilot sites