Understanding the implementation and impact of remote monitoring pathways in Integrated Care Systems

Summary

The development of virtual wards and remote care solutions accelerated rapidly during the height of Covid-19 to monitor patient health at home and keep people out of hospital. Now this approach to healthcare is being expanded for a wide range of conditions and patient cohorts.

Remote monitoring offers an opportunity for patients to track their progress at home with regular reviews from clinicians. 

Despite this rapid expansion, relatively little is known about the types of patients that should be prioritised for remote monitoring (regardless of condition); the impact of remote monitoring on service use (resources needed to deliver; onwards impacts on emergency attendances, length of stay and readmissions); the impact on staff roles, accountability and satisfaction; and patient experience.

Further exploration is also required into the impact of these pathways on health inequalities for a range of patients.

Understanding these impacts is essential to support informed commissioning; ensure patients are fully experiencing the benefits; supporting the NHS to reset and recover from Covid-19 and realising the ambitions of the NHS Long Term Plan.

• This project resulted in practical and accessible implementation guidance for healthcare organisations and patients, highlighting how to make best use of remote monitoring, with a focus on 4 different pathways. This benefited:
  • Healthcare providers looking to improve and refine existing remote monitoring pathways – including insight into scaling pathways for maximum impact and appropriate support for staff.
  • Healthcare providers looking to implement new remote monitoring pathways, including key factors for consideration during planning, set-up and delivery.
  • Patients who are using remote monitoring – particularly through clear patient guidance for engaging with remote monitoring solutions as well as helping trusts identify the most appropriate patients for remote monitoring and any support needs that should be considered and put in place.
  • Commissioners who want to make informed commissioning and de-commissioning decisions about remote monitoring pathways, particularly in relation to patient outcomes and cost consequences.
• Assessing health inequalities is a key part of the work which we will address through understanding who is and is not well served by remote monitoring, and how patients are currently assessed, triaged and supported. We examined how sites have engaged hard-to-reach groups and explored hypotheses generated through qualitative exploration in the quantitative analysis (such as clinical outcomes for e.g. those living in deprived areas).
• We were alerted to the potential of unintended consequences (patient and pathway level) via qualitative work with staff and patients and will explore these further through quantitative analysis wherever possible.

Project Outcomes

• Four separate evaluation reports are currently in preparation for the 4 participating sites.
• Further outputs are also being drafted, including the Lived Experience Advisory Panel impact report, which will be used to form a case study for the PCIEP theme; and a cross-cutting implementation guide.
• We are working with Comms teams at the AHSN, ARC and University of Hertfordshire to plan dissemination channels based on an earlier stakeholder mapping exercise.
• The research has also been presented as part of a keynote presentation at the National Telehealth Conference 2024 in Sydney and will be disseminated via an academic journal paper.

Who was involved?

• Dr Jennifer Lynch, University of Hertfordshire

j.lynch5@herts.ac.uk

• Sophie Castle-Clarke, Eastern AHSN

Sophie.castle-clarke@eahsn.org

Institutions 

• Hertfordshire Community NHS Trust
• East and North Hertfordshire NHS Foundation Trust
• Cambridgeshire Community Services NHS Trust
• Mid and South Essex NHS Foundation Trust
• East Midlands AHSN footprint:
• Northampton General Hospital NHS Trust

Find out more here.