Liverpool self-care programme cuts emergency admissions

A study of a large scale, supported self-care programme in Liverpool has found clear reductions in emergency admissions and secondary care costs for some patients.

The study, which was launched at the King’s Fund with the support of NHS Liverpool Clinical Commissioning Group and Philips, also attempted to address some of the issues that have bedevilled previous attempts to measure the impact of telehealth and telecare.

The research into the More Indpendent or Mi programme examined whether a patient having an emergency admission to hospital was a good predictor of further emergency admissions; and argued that other risk factors, such as age and having a long-term condition, “provide a better way to select patients.”

It also addressed the fact that people who have one or more emergency admissions in one year are likely to have fewer admissions in the following year; making simple claims about the benefit of putting such patients on telehealth programmes unreliable.

The study noted that one reason admissions can be high one year and low the next is that people who have been admitted to hospital receive high quality healthcare, which improves their condition. However, it argues that the regression is predictable and can be modelled.

The research, which has been seen by Digital Health News although the full report has not been put into the public domain, takes this into account and focuses on the risk factors for the patients in its cohort being admitted to hospital.

It found that the average risk of this happening was only 26%. “The broad spread of the population has been one of the factors for success for the programme, however it means that overall only one in the three patients in the cohort was expected to have an emergency admissions in the next 12 months,” the report says.

“Hence, while significant reductions in emergency admission can be expected and measured in the top half of the cohort, for the bottom half the impact needs to be measured over longer periods or by different means.”

The Mi programme is built around a clinically staffed hub that engages with GPs and other stakeholders, recruits patients, and looks after monitoring and case management.

Patients recruited to the programme use the Philips Motiva technology, which consists of a tablet or TV-set top-box that can be wirelessly connected to scales, blood pressure cuffs and pulse oximeters. Patients also receive videos and questionnaires that are used to check aspects of their condition.

Overall, the report found there were reductions in emergency admissions and secondary care costs among those taking part in the programme that ranged from 22% to 32% for patients with above average risk. The saving built up over time, and peaked at around seven months; with a gross saving of £499 after six months.

The study also concluded, as previous studies have done, that patients on the programme tended to feel more in control of their condition and to report improvements in lifestyle and health; with around 90% saying they felt more in control and half saying they had seen an improvement in their wellbeing.

In a statement, Dr Simon Bowers, the digital care and innovation clinical director at NHS Liverpool CCG, described these results as “game-changing”.

“This is really good for the NHS, but more importantly it is good for the individual patients who are being empowered to take control of their health and have the opportunity of a better quality of life as a result,” he said.

Jeroen Tas, chief executive for connected care and health informatics at Philips Healthcare, said the company was committed to partnerships such as the one in Liverpool “that help realise system efficiencies… that are potentially vital for securing the future health of the NHS and for providing patients with tailored and continuous health support.”