Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

Dixon, P. et al. BMJ Open. 6:e012352

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Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objectives: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.

Design: A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.

Setting: Patients recruited through primary care, and intervention delivered via telehealth service.

Participants: Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.

Intervention: A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.

Primary and secondary outcome measures: Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.

Results: 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.

Conclusions: There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.

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Managers’ use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact

Burton, C. et al. BMJ Open. 6:e013645


Introduction: Nursing staffing levels in hospitals appear to be associated with improved patient outcomes. National guidance indicates that the triangulation of information from workforce planning and deployment technologies (WPTs; eg, the Safer Nursing Care Tool) and ‘local knowledge’ is important for managers to achieve appropriate staffing levels for better patient outcomes. Although WPTs provide managers with predictive information about future staffing requirements, ensuring patient safety and quality care also requires the consideration of information from other sources in real time. Yet little attention has been given to how to support managers to implement WPTs in practice. Given this lack of understanding, this evidence synthesis is designed to address the research question: managers’ use of WPTs and their impacts on nurse staffing and patient care: what works, for whom, how and in what circumstances?

Methods and analysis :To explain how WPTs may work and in what contexts, we will conduct a realist evidence synthesis through sourcing relevant evidence, and consulting with stakeholders about the impacts of WPTs on health and relevant public service fields. The review will be in 4 phases over 18 months. Phase 1: we will construct an initial theoretical framework that provides plausible explanations of what works about WPTs. Phase 2: evidence retrieval, review and synthesis guided by the theoretical framework; phase 3: testing and refining of programme theories, to determine their relevance; phase 4: formulating actionable recommendations about how WPTs should be implemented in clinical practice.

Ethics and dissemination: Ethical approval has been gained from the study’s institutional sponsors. Ethical review from the National Health Service (NHS) is not required; however research and development permissions will be obtained. Findings will be disseminated through stakeholder engagement and knowledge mobilisation activities. The synthesis will develop an explanatory programme theory of the implementation and impact of nursing WPTs, and practical guidance for nurse managers.

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Innovative use of technology key to improving patient outcomes

via OnMedica

image source: Phil Renaud – Flickr // CC BY-NC-ND 2.0

Use of technologies that enable risk stratification, early detection, appropriate intervention and remote monitoring are key to improving patient outcomes, finds a progress report of ‘vanguard’ sites published more than a year after the introduction of the programme.



The vanguard programme was developed as part of the Five Year Forward View, which aims to change the commissioning landscape and take advantage of scientific and technological advances.

The objective is for the sites to come up with creative, ambitious and innovative solutions to address health and social care needs locally, and trial them, as well as developing plans for long-term investment to improve population health and reduce pressure on services.

The progress report from NHiS Commissioning Excellence draws on the experiences of an advisory panel of eight participating sites, representing health and care provision across different settings, who shared their insights in March 2016, a year on from the formation of many vanguards.

Full report: The Role of Vanguards in the Development of New NHS Commissioning Structures. A report from NHiS Commissioning Excellence


Early intervention

Briefing Paper: Early Intervention. House of Commons Library, 7 July 2016

Early intervention is a public policy approach which encourages preventative intervention in the lives of children or their parents, to prevent problems developing later in life. Interventions can either be targeted at children deemed to be at higher risk of disadvantage, or can be universal in scope.

As well as the political and social benefits of preventing poor outcomes in later life, such as mental health problems, low educational attainment and crime, advocates of early intervention also cite economic benefits to the approach. This is based on the argument that preventative policies cost less to implement than reactive policies.

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This paper provides information and analysis on early intervention policies aimed at parents and children from conception to age five, covering health, education, social development and financial benefits.

This paper also looks at broader arguments around early intervention as a policy approach.


You can view the full document here

Management of controlled drugs

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The Care Quality Commission has published The safer management of controlled drugs Annual report 2015. This report highlights local and national initiatives to promote the safe use of controlled drugs and to reduce harm from their misuse. It also includes an overview of data for 2015 on prescribing of controlled drugs across England in the primary care sector and identifies any trends in prescribing, and highlights key changes to legislation. The report makes three recommendations to strengthen existing arrangements for reporting and sharing concerns about controlled drugs across England.

Supporting young people from care to independence

This cross-government strategy to transform support for young people leaving care has been published. It looks at how to improve services, support and advice for care leavers. It makes recommendations for local and national government, and wider sectors of society.

The report identifies three key ways in which improvements will be made in leaving care services:

Firstly, it sets out how the Innovation Programme will be used to rethink how services are delivered and what support is provided, with a strong focus on finding new and better ways of helping care leavers develop the social networks that will sustain them not just in the years immediately after leaving care, but throughout their lives.

Secondly, it sets out how the culture of corporate parenting will be strengthened , both locally – through planned legislative measures – and through changes to central government policies, so that they better respond to care leavers’ unique status and circumstances.

Finally, it sets out how local areas will be supported and challenged , so that all deliver to the standards of the best.

Full reference: Keep On Caring: Supporting Young People from Care to Independence

Value of health initiative

The Royal College of Physicians has joined a group of leading health organisations from across Europe in an initiative to improve quality of care and public health.

The ‘Value of health Improving outcomes’ project calls for a stronger focus on health outcomes, including a more robust approach to how they are measured, to bring about the following benefits: improve quality of care for patients; strengthen public health interventions; contribute to wider economic goals and increase societal well-being.

View the Value of Health project description here

Prevention and management of patient deterioration

 NHS Improvement has published two pieces of shared learning and an improvement tool aimed at preventing and managing patient deterioration:

Integrated care for older people

The Care Quality Commission (CQC) has published Building bridges, breaking barriers.

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This report looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers.  This review enabled the CQC to independently assess the current state of integrated care within fieldwork sites, to develop and pilot tools and methods to support future reviews of coordinated care and to inform CQC’s approach to the new models of care that are emerging.