Lancashire and Cumbria Innovation Alliance Test Bed: Final Evaluation Report for a Targeted Supported Self-Care Programme (original) (raw)

Over a period of 30 months, the Lancashire and Cumbria Innovation Alliance Test Bed implemented and evaluated a combination of innovative technologies and practices aimed at supporting older people (aged 55+) with long-terms conditions (LTCs) to remain well in the community, avoiding unnecessary hospital admissions. The combinatorial health technologies were designed to better enable older people with LTCs to self-care at home and to improve patient activation. The LTCs included COPD, heart failure, asthma, diabetes and dementia-conditions that present a major challenge for the Northwest. Patients with LTCs were recruited to one of three cohorts depending on their level of risk of hospital admission (Cohort 1 being the highest risk category); individuals with mild to moderate dementia were recruited to Cohort 4. The combination of technologies each patient received was dependent on their level of risk and their primary LTC. The Test Bed evaluation focused on two key outcomes: i) the extent to which supported selfcare health technology might improve patient outcomes and the patient experience for frail older people living with long-term conditions; and ii) the potential cost effectiveness of the intervention and how this might be scaled up to provide better value for both patients and taxpayers. The evaluation adopted a two-phase approach: Phase 1 included a bespoke patient survey and a matched control analysis (3:1); Phase 2 adopted a qualitative approach including observational interviews with patients and carers; and weekly diaries, action learning meetings, and focus groups with members of staff and other key stakeholders. The evaluation was underpinned by a Logic Model to aid spread and adoption. Key Messages  The data showed that the use of Test bed technology made little difference to hospital service usage; vi Staff  The Test Bed enabled members of staff to have more contact and connections with their patients, with many welcoming the added diversity the programme brought to their role.  Time was a key challenge for successful delivery, with the Test Bed resulting in additional workload for those operating on the front line. Protected time is required for successful delivery of a programme such as this, particularly in the implementation stage and especially for patients with dementia.  A small number of patients and carers required significant reassurance and support in using the technologies. In these cases, service utilisation increased during the Test Bed programme.  Many people engaged with, and received, better healthcare as a result of Test Bed participation. The short-term increases in service utilisation were viewed by staff as a positive outcome as patients were receiving better and more appropriate care.  Though the Phase 1 data showed little change over the duration of the Test Bed, staff maintained that improved healthcare, arising from the Test Bed programme, would result in a reduction of emergency care and hospital admissions in the long term.  Staff across the Test Bed highlighted the importance of being part of a willing and engaged team when embarking on such a programme. Good communication and working relationships are key to successful implementation.  Where staff felt ownership of the programme and were involved in decision-making, there was greater buy-in and support for the Test Bed. Conversely, where staff were not involved in decision-making, or ownership was not encouraged, staff felt disengaged from the process.  Issues arose throughout the Test Bed as a result of clinical teams not being involved in decisions and programme design from an early stage. This included members of staff being expected to refer their patients into the Test Bed while not knowing what the technology entailed, and technology content contradicting advice given to patients by healthcare teams.  It is important that staff receive appropriate and regular training and support if they are to understand the technologies, how they can be tailored to the individual, and their value to their patients.  Continuity in the staff responsible for identifying and managing patients using healthcare technologies is important to its successful implementation.