Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

Objective To assess the effect of home based telehealth interventions on the use of secondary healthcare and mortality.Design Pragmatic, multisite, cluster randomised trial comparing telehealth with usual care, using data from routine administrative datasets. General practice was the unit of randomi...

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Bibliographic Details
Published in:BMJ (Online) 2012-06, Vol.344 (jun21 3), p.e3874-e3874
Main Authors: Steventon, Adam, Bardsley, Martin, Billings, John, Dixon, Jennifer, Doll, Helen, Hirani, Shashi, Cartwright, Martin, Rixon, Lorna, Knapp, Martin, Henderson, Catherine, Rogers, Anne, Fitzpatrick, Ray, Hendy, Jane, Newman, Stanton
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Cluster Analysis
Emergency Service, Hospital - statistics & numerical data
Emergency Service, Hospital - utilization
England - epidemiology
Epidemiologic Studies
Female
General Practice
Hospitalization - statistics & numerical data
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Mortality
Telemedicine
Young Adult
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Summary:Objective To assess the effect of home based telehealth interventions on the use of secondary healthcare and mortality.Design Pragmatic, multisite, cluster randomised trial comparing telehealth with usual care, using data from routine administrative datasets. General practice was the unit of randomisation. We allocated practices using a minimisation algorithm, and did analyses by intention to treat.Setting 179 general practices in three areas in England. Participants 3230 people with diabetes, chronic obstructive pulmonary disease, or heart failure recruited from practices between May 2008 and November 2009.Interventions Telehealth involved remote exchange of data between patients and healthcare professionals as part of patients’ diagnosis and management. Usual care reflected the range of services available in the trial sites, excluding telehealth. Main outcome measure Proportion of patients admitted to hospital during 12 month trial period. Results Patient characteristics were similar at baseline. Compared with controls, the intervention group had a lower admission proportion within 12 month follow-up (odds ratio 0.82, 95% confidence interval 0.70 to 0.97, P=0.017). Mortality at 12 months was also lower for intervention patients than for controls (4.6% v 8.3%; odds ratio 0.54, 0.39 to 0.75, P
ISSN:0959-8138
1756-1833
1756-1833
DOI:10.1136/bmj.e3874