Authors' objectives: Many of the medical emergencies that occur in people with long term medical conditions such as heart failure are, in fact, the endpoint of a slow process of deterioration over days or weeks. This deterioration might be caused by a factor such as being on the wrong dose of a medication that could be influenced if doctors and nurses were aware that the deterioration was occurring. Currently, deterioration may not come to medical attention until symptoms and signs are severe, leading to presentation at A&E and hospital admission. Over the last few years a wide range of new technologies have been developed to address this problem. To date, however, it has been difficult to justify the high costs of the equipment, especially given that it is often difficult to use and therefore a burden on patients and their caregivers. In addition, because these systems were not designed to integrate the information they collect with stored electronic health records, they often lacked sufficient information to generate accurate alerts. This research study aims to leverage the opportunities that have been generated by two recent advances to try to overcome these issues. The first is the wide accessibility of conventional tablet computers, which offer a simple interface for patients to enter their symptoms and to gather the readings automatically from wireless sensors. Due to recent dramatic falls in the price of computers, a tablet computer that is as powerful as the most advanced computer systems were just a few years ago can now be bought from a supermarket for a few hundred pounds. We have recently evaluated the use of such a tablet-based home monitoring platform and found that patients thought it was easy to use and that it could reliably collect the readings and symptom scores from patients. The second development is the ability to link the tablet computer over the mobile phone network to electronic health records (EHR) system. EHR systems are replacing the paper notes system that doctors and nurses previously used to record information about patients under their care. Using the electronic notes system, our computer system can quickly pull out the information without needing a doctor or nurse to read the notes first. When we combine the information in the EHR with the information collected on the tablet computer, we can create a very detailed picture of the current status of a patient and whether or not they need a doctor or nurse to intervene to change their medication, for example. This could improve quality of life, reduce the number of emergency visits to hospital and might alter prognosis. For patients with chronic heart failure, we will investigate whether such an integrated system with support from a central specialist team improves the effectiveness of a home tele-monitoring system, designed to assess symptoms, heart rate, blood pressure, weight and physical activity. During a pilot phase, 350 patients will be randomly assigned to the intervention or control groups. For the group assigned to the intervention, we will provide tools for both the patient and the clinical team looking after them that will alert them to possible deterioration in their health status and offer remedial action. If the pilot is successful, we will proceed to investigate whether such an integrated system improves the quality and efficiency of care, improves patient well-being, reduces emergency hospitalisations and perhaps even prolongs life.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/13114102

Year Published: 2017

URL for published report: http://www.nets.nihr.ac.uk/projects/hsdr/13114102

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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