#nhstestbeds NHS Test Beds: Testing innovations in real world settings
#nhstestbeds Test Beds Wave 1 51 digital products 4000+ patients recruited Test Beds Wave 1 75 partnership organizations 40 innovators 8 evaluation teams
7 Test Beds Sites 1 Lancashire and Cumbria Innovation Alliance, Lancashire and Cumbria 3 Long term conditions early interventions programme Greater Manchester 2 Perfect Patient Pathway Sheffield 5 Diabetes Digital Coach West of England 4 RAIDPlus Birmingham 7 Care City North East London 6 Technology Integrated Health Management Surrey
#nhstestbeds Lessons from Wave 1 Information governance Evaluation Building effective partnerships Handbooks will be available on our website: https://www.england.nhs.uk/ourwork/innovation/test-beds/
#nhstestbeds Building on Wave 1 6 collaboration events 21 candidates interviewed Set-up phase 337 expressions of interest 78 completed applications New Test Beds announced Testing begins! Test Wave Beds 2 Wave 2
#nhstestbeds Impact and learnings at Wave 1 sites
Partnership working Care City Test Bed Perspective 6 th September 2018 John Craig, CEO, Care City Glyn Barnes, Marketing Director, AliveCor
If time is invested upfront, true collaboration can be achieved Contributions Time commitment from individuals, teams & stakeholders Knowledge sharing about the product and the health condition it seeks to improve Ideas & openness understanding how the product works for us & how it could work for others Traction staying focussed and relentless to yield results Added value bringing stakeholder groups together to learn quickly from each other Design intelligently integrating & promoting the use of the product Key Advice 1. Share the same values 2. Take a collaborative approach 3. Get the basics right
LANCASHIRE AND CUMBRIA INNOVATION ALLIANCE Test Bed Programme Dr Mark Denver, Lead Clinician, The Bay
Population of 1.4 m
Challenges Size, range and number of organisations collaborating (governance, IT) Engagement (professionals and the public) Recruitment of clinical staff, which requires lead-in time (who employs staff ) Learning as you go (action learning meetings) Managing the tensions between evaluation & recruitment Varied interpretation of risk (GPs, ANPs, community nurses) Procurement and commissioning
Key findings from Wave 1 Quality Impact: 86% C1 & 83% C2 indicated an increased confidence about their health 68% <25 & 94%<10-25 indicated increased knowledge and skills enabling selfmanagement of LTC Improvement in activation for those with lowest levels (PAM13 scores) Efficiency Impact: 10% reduction in primary care community and Emergency services for C1 Increase in C2 of 12% which is positive as this indicates appropriate use of these services 2.7% decrease in probability in being admitted to hospital Financial Impact: Early detection of previously undiagnosed health problems 10% reduction in primary care community and Emergency services for C1 Increase in C2 of 12% which is positive as this indicates appropriate use of these services preventing escalation of risk 2.7% decrease in probability in being admitted to hospital It is important to acknowledge both the strengths and limitations of the Wave 1 evaluation approach, including the time-frame of the Test Bed which may have been too short to accurately measure changes in health care usage, and also patient age restriction and cohort risk stratification.
1) 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. 2) Phase 1 data indicated that during the Test Bed there were improvements in experience of healthcare, arising from the Test Bed programme, resulting in a reduction of emergency care and hospital admissions in the long term. 3) Decisions about which combinatorial technologies to give to a patient should begin and end with the individual s healthcare needs, and not what technologies are available. 4) Patients and clinicians need to work together to understand what technologies will best work for each individual. 5) Patients want technologies that can be tailored to individual needs, or personalised to their own lifestyles. 6) Good training, induction and ongoing support is essential for the successful implementation of Test Bed technologies. 7) Issues arose throughout the Test Bed as a result of clinical teams not being involved in decisions and programme designs 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.
The next phase of the LCIA Test Bed Joint Commissioners COG: Clinical lead on a local commissioning group which forms a decision making process with both The Bay and Fylde Coast. Aim is to discuss and form a plan on a page and business case to help local commissioners demonstrate business as usual.
TIHM for dementia Technology Integrated Health Management Using technology to improve the quality of life for people with dementia Dr. Theti Chrysanthaki, Process Evaluation Lead
TIHM for dementia: the co-designed solution 930,000 people in UK with dementia > 1 million 2025 1 in 4 hospital beds occupied by a person with dementia 22% of unplanned admissions preventable Dementia - complicated disease with associated co-morbidities Carer burnout key reason for care home admission TIHM provides actionable clinical data to support early intervention lead to: Improved quality of life for people with dementia and carers Reduced pressure on acute NHS services
Reasons for choosing an RCT to evaluate TIHM Evaluating the effectiveness of a domiciliary IoT intervention for people with dementia and their carers Standard care Vs. standard care plus technology 204 dyads: 102 control and 102 intervention Primary outcome: whole system health and social costs Secondary outcomes: quality of life, carer stress
The challenge of an RCT in a complex area of development Context: Dementia is a complex, variable condition with many unknowns No blue print new innovation with many partners and limited time to develop RCT = standardisation of intervention delivery with no iterative improvements allowed Result: Intervention evolved over time Challenge to standardisation of intervention delivery, effects could be undetectable Solution: Comprehensive process evaluation leads to Capturing complexity Mapping changes over time Understanding process by which intervention may or may not deliver, and in what context Users experiences used to improve intervention and increase acceptability. A carer and one of our Trusted Users discusses his involvement in fine tuning the intervention show clip
TIHM for dementia Carer Representative: Trevor Truman https://www.youtube.com/watch?v=oxduwsmffgo
Complex interventions require complex designs Research pluralism RCT has a place but in the context of technology and dementia co-design and reflexivity are also important Action research for improvement cycle (plan, act, reflect)
#nhstestbeds Questions?
#nhstestbeds Sharing lessons from Wave 1 Partnerships Glyn Barnes & John Craig Care City Test Bed Pippa Takhar & Jamie Innes Digital Care Home, PePPa Test Bed Janet Davies & Mark Denver LCIA Test Bed Information governance Eric Applewhite National IG partner (Kaleidoscope / KPMG) Amy Ford National IG partner (Kaleidoscope / KPMG) Kiran Mistry internal IG specialist (NHS England) Shaid Hussein internal IG specialist (NHS England) Evaluation Dr. Theti Chrysanthaki TIHM for Dementia Local Evaluation Partner (University of Surrey) Dr. Karen Windle National Evaluation Partner (NatCen Social Research) Nick Woolley National Evaluation Partner (Frontier Economics)