Proactive and patient-centered telecare
Aim and focus – The initiative focusses on proactive and person-centered telecare to support frail and
vulnerable people applying (medical) risk stratification. Recent research, has identified the increase in average time that service users were able to live safely and independently with progressively more advanced support, extending their use of the service with an average of 1,5 years. As a result of the increasing mean age at cessation, concern was raised regarding potential impact on ambulance mobilisations as an indicator of wider emergency healthcare demands. The purpose of this study was therefore to investigate this impact.
Patient or Service User description – The population under study was the telecare service users of Televida Servicios Sociosanitarios, one of the largest providers of telecare services on behalf of regional municipalities in Spain. Commencing in the 1990’s, Spain pioneered progressively more advanced telecare approaches to help proactively support service users’ physical and mental health conditions leading to increased risks such as falls, as well as wider social situations such as isolation (referred to as proactive telecare). This has become more advanced over time, with more recent developments including risk stratification to enable support to be directed most efficiently to service user needs (referred to as person-centered telecare).
The population was subject to change over time as new service users became eligible to register for the
service, and others ceased the service. Each of these factors were also studied to assess potential
confounding or covariate factors in the population also influencing the mobilisation of ambulances.
Research Methodology and Conclusions – A longitudinal study of a telecare service user population in Spain (n=202.1k to 247.9k) was undertaken using anonymised operational data collected in the delivery of proactive and person-centered telecare services over the period 2014-18. For the studied population,
ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. The study identified the positive correlation coefficient between ambulance mobilisations and service user’s or patients dependency levels, and marginal negative correlation in older age bands. The share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service which appear to have contributed to increased time living independently may also have helped ensure those continuing to live independently remain in lower risk bands. IPUs – IPUs involve local authority social workers, response center operators, emergency supervisors, first responders, allied professional services and cares. Both in Spain and adopting countries public private partnerships collaborate to providing Home Care. Additional initiatives include IPUs providing similar patient value in Care Homes. Value for payers – Transparent input is provided to local and regional payers for budget and quality management, including a real-life dashboard including health population data in wider regions for comparative and data driven decision making. The SROI methodology has been used to support insight and adoption of the initiative in local healthcare systems.