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A Whole System Approach to Developing Telecare Strategy Paul Forte The Balance of Care Group www.balanceofcare.com. Telecare and telemedicine. Telecare:

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A Whole System Approach to Developing Telecare StrategyPaul ForteThe Balance of Care Groupwww.balanceofcare.com

telecare and telemedicine
Telecare and telemedicine
  • Telecare:

Continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.

  • Telemedicine:

The use of medical information exchanged via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. It includes consultative, diagnostic, and treatment services.

developing a business case for telecare
Developing a businesscase for telecare
  • It’s more than installing alarms and having a call centre:
    • what kind of service are you planning to provide for people at home?
    • who should it be provided for?
    • how does it connect with wider health and social care strategy?
  • …and how do you prevent schemes from becoming ‘yet another pilot’?
local telecare developments
Local telecare developments
  • How does what’s currently underway locally fit with existing service provision?
  • Expansion of telecare – what will the local implications be for:
    • service reconfiguration?
    • information flows and exchange?
  • Evaluation of telecare projects
slide6
New technology + Old system

=

Expensive old system

a whole system perspective
A whole system perspective

Pre admission

Pre admission

Admission

Diagnosis

Treatment

Discharge

Re-admission

Social details

alone, carers, residence

Risk factors:

age, drugs, co-morbidities,

psychiatric/

dementia, falls

Preventative care

Disease managementManaged populations

Source of referral

Time

Waiting time

Route

Decision maker

Reason for admission

Alternatives to acute admission setting

Discharge planning

Delays in planning

Delays in execution

Alternative sites for discharge

Admission diagnosis

Inpatient diagnosis

Delays in diagnosis

Chronic disease

Alternative access for diagnosis

Delays in therapy

Alternative settings for therapy (especially rehab)

‘Revolving door’

Avoidable e.g. chronic disease management

Alternative sites for readmission

© Balance of Care Group

the balance of care model
The Balance of Care model

high

dependency

medium

dependency

Older

People

low

dependency

© Balance of Care Group

the balance of care model9
The Balance of Care model

long term

care bed

high

dependency

NHS

community nurse

physiotherapist

medium

dependency

Older

People

respite care

day care centre

Local

Authority

care assistant

low

dependency

telecare equipment

Voluntary &

independent sector

care home

© Balance of Care Group

the balance of care model10
The Balance of Care model

long term

care bed

high

dependency

NHS

option1

community nurse

physiotherapist

medium

dependency

Older

People

option 2

respite care

day care centre

Local

Authority

option 3

care assistant

low

dependency

telecare equipment

Voluntary &

independent sector

care home

© Balance of Care Group

balances to be struck
Balances to be struck

Care Professionals

Non-Clinical Managers

Social Services

Health Services

High Dependency

Low Dependency

category descriptions
Category Label

Intended Population Base

Data Source for Telecare Valley

Care home residents - not EMH

Permanent care home residents over 65 supported by council (excluding Elderly Mental Health)

England residents at 31-03-2004 / 150

Care home residents - EMH

Permanent care home residents over 65 supported by council (Elderly Mental Health)

England residents at 31-03-2004 / 150.

Case management - frail older people

Numbers over 65 receiving intensive home care (> 10 hours per week). These are assumed to be the people who would be included in case management schemes for frail older people.

Based on England number receiving intensive home care (over 10 hours) at 31-03-2004 / 150.

Other long term care needs

Numbers over 65 receiving home care (5- 10 hours per week). These are assumed to be the people who require continuing social care support, but do not have chronic healthcare needs appropriate for case management.

Based on England number receiving 5-10 hours of home care at 31-03-2004 / 150

Other low intensity needs

Numbers over 65 receiving home care (< 5 hours per week)

Other England low intensity home care (<5hrs per week) at 31-03-2004 / 150

Unsupported at home >65

Total resident population 65 years and over, not receiving a social care service

England 2001 Census, resident population over 65, divided by 150, and net of estimated values for P1 to P5 inclusive.

Category descriptions
building the business case the way ahead
Building the business case: the way ahead…
  • Organisational issues:
    • partnership working? innovative connections? workforce / skills development?
  • Information issues:
    • Access/ sharing data? Information exchange? common definitions/ criteria?
  • …while bearing in mind…
    • need to harness the drive of health and social care professionals, clients and carers
evaluating complexity
Evaluating complexity
  • How do we evaluate a complex adaptive system which is:
    • always changing?
    • subject to constantly shifting goal posts?
  • Evaluation on a multi-dimensional framework
    • variation over time
    • variation between similar system
the balanced scorecard approach
The ‘Balanced Scorecard’ approach
  • Evaluation on several dimensions such as:
        • care/ clinical outcomes
        • patient/ client satisfaction
        • systems process outcome
        • cost/ cost effectiveness
  • All within the same time frame
  • Using a wide range of agreed quantitative and qualitative measures and tools
key issues
Key issues
  • Identifying communities and networks of care
  • Role of telecare as a network ‘enabler’
  • Integration and sharing of information
  • Configuration of service response and delivery
  • Evaluation
policy assumptions
Policy assumptions
  • Main focus on social care
  • Restrict to ‘currently supported’ clients
  • Investment in ‘response mode’ telecare only
  • Model populated for average council - ‘Telecare Valley’

Of course, these assumptions can be

varied to suit local applications

cycle of evaluation and strategy generation
Cycle of evaluation and strategy generation

Strategy

knowledge

Operation

practice

Re-envisioning

reviewing

learning

Evaluation

complex adaptive systems
Complex adaptive systems

‘A complex adaptive system is a collection of different agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent’s actions changes the context for other agents – examples are the immune system, a colony of termites, the financial market… and just about any collection of human beings.’

Plsek 2001

criteria to consider
Criteria to consider
  • What will we measure?
  • How will we measure it?
  • How and to whom will it be reported?
  • What are the changes necessary and how will they be implemented?
  • What have we learned?
possible outcomes to be measured 1
Possible outcomes to be measured: 1
  • Care outcomes:
          • deaths and morbidity measures
          • hospital admissions avoided/patients kept at home
          • improved clinical function
          • better medicines management
  • Customer satisfaction:
          • patient/ client satisfaction questionnaires
          • referrers satisfaction (timeliness, one call, etc)
possible outcomes to be measured 2
Possible outcomes to be measured: 2
  • Processes
        • accessibility
        • use and appropriateness of technology
        • monitoring and availability of data base
        • functioning of ‘expert teams’
  • Cost
        • total budgets
        • banded costs per episode
        • comparative costs of community compared with hospital care
steps in evaluation
Steps in evaluation
  • Build an ‘external evidence’ database
  • Agree a set of evaluation measures with users
  • Use first small-scale trials of TM equipment to prove whether these measures are sufficient and if data can be readily obtained
  • Refine evaluation measures
  • Roll-out on a larger scale
  • Reporting cycles and timescales
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