title: Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial.
abstract: OBJECTIVE
  to assess the impact of telecare on the use of social and health care. Part of the evaluation of the Whole Systems Demonstrator trial.
  
  
  METHODS
  a total of 2,600 people with social care needs were recruited from 217 general practices in three areas in England.
  
  
  METHODS
  a cluster randomised trial comparing telecare with usual care, general practice being the unit of randomisation. Participants were followed up for 12 months and analyses were conducted as intention-to-treat.
  
  
  METHODS
  trial data were linked at the person level to administrative data sets on care funded at least in part by local authorities or the National Health Service.
  
  
  METHODS
  the proportion of people admitted to hospital within 12 months. Secondary endpoints included mortality, rates of secondary care use (seven different metrics), contacts with general practitioners and practice nurses, proportion of people admitted to permanent residential or nursing care, weeks in domiciliary social care and notional costs.
  
  
  RESULTS
  46.8% of intervention participants were admitted to hospital, compared with 49.2% of controls. Unadjusted differences were not statistically significant (odds ratio: 0.90, 95% CI: 0.75-1.07, P = 0.211). They reached statistical significance after adjusting for baseline covariates, but this was not replicated when adjusting for the predictive risk score. Secondary metrics including impacts on social care use were not statistically significant.
  
  
  CONCLUSIONS
  telecare as implemented in the Whole Systems Demonstrator trial did not lead to significant reductions in service use, at least in terms of results assessed over 12 months.
authors: The Nuffield Trust, London, UK. adam.steventon@nuffieldtrust.org.uk
authors: Adam
authors: A
authors: Steventon
authors: Martin
authors: M
authors: Bardsley
authors: John
authors: J
authors: Billings
authors: Jennifer
authors: J
authors: Dixon
authors: Helen
authors: H
authors: Doll
authors: Michelle
authors: M
authors: Beynon
authors: Shashi
authors: S
authors: Hirani
authors: Martin
authors: M
authors: Cartwright
authors: Lorna
authors: L
authors: Rixon
authors: Martin
authors: M
authors: Knapp
authors: Catherine
authors: C
authors: Henderson
authors: Anne
authors: A
authors: Rogers
authors: Jane
authors: J
authors: Hendy
authors: Ray
authors: R
authors: Fitzpatrick
authors: Stanton
authors: S
authors: Newman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017046:Cost Savings; D004739:England; D005260:Female; D058006:General Practice; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006699:Home Care Services; D006801:Humans; D057194:Intention to Treat Analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009819:Office Visits; D010343:Patient Admission / Q000191:economics; D016016:Proportional Hazards Models; D012112:Residential Facilities; D063127:Secondary Health Care; D012947:Social Work / Q000191:economics / Q000379:methods*; D013222:State Medicine / Q000191:economics / Q000706:statistics & numerical data; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data; D013997:Time Factors
keywords: administrative data; assistive technology; older people; randomised controlled trial; telecare