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DEPARTMENT OF VETERANS’ AFFAIRS

EVALUATION OF THE IN-HOME TELEMONITORING FOR VETERANS TRIAL

APPENDICES TO FINAL REPORT

AUGUST 2017

HEALTH OUTCOMES INTERNATIONAL5A Glynburn Road, Glynde, SA 5070 | P: 08 8363 3699 | F: 08 8365 3560 E: [email protected] | www.hoi.com.au

Department of Veterans’ AffairsEvaluation of the In-home Telemonitoring for Veterans’ Trial

CCONTENTS

APPENDIX A – OBJECTIVES OF THE EVALUATION...............................................

APPENDIX B – SUMMARY OF COMPARABLE TRIALS............................................

APPENDIX C – ANALYSIS OF DMIS DATA.......................................................

APPENDIX D – AQOL 8D QUESTIONS AND ANALYSIS....................................

APPENDIX E – KESSLER 10 QUESTIONS AND ANALYSIS................................

APPENDIX F – PARTICIPANT SURVEY ANALYSIS............................................

APPENDIX G – PRACTICE SURVEY ANALYSIS................................................

APPENDIX H – CASE STUDY QUESTIONS......................................................

APPENDIX I – COST EFFECTIVENESS ANALYSIS-DETAILED CALCULATIONS.......

Appendices to Final reportAugust 2017

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AAPPENDIX A – OBJECTIVES OF THE

EVALUATIONThe following provides a full description of the objectives for the evaluation.

1. If telemonitoring is a safe, effective and efficient way to complement conventional health services. This may be indicated by, but not limited to, factors such as: no harm to intervention group participants telemonitoring equipment functioning optimally quantity and quality of telemonitoring consultations meets or exceeds

expectations more convenient and timely access to healthcare services for intervention group

participants the existence of the technology in the home does not cause veterans to overuse

the technology (i.e. they become overly focussed on their health and wellbeing and constantly use the available monitoring equipment)

healthcare providers continue to meet, or exceed, relevant healthcare standards for services provided to intervention group participants.

2. If there is an improvement in monitoring and management of selected complex chronic conditions for veterans. This may be indicated by, but not limited to, factors such as: access to high quality healthcare for intervention group participants, at least

equivalent to current levels of care each intervention group participant receiving regular monitoring of their condition,

education and feedback from the practice nurse and/or the relevant health services provider

appropriate intervention by practice nurses, and assessment by the participant’s general practitioner (GP)

examples of reduced financial, physical and time commitments for carers improved self-management through on-going monitoring and care of intervention

group participants reduced physical visits to health professionals by intervention group participants

in correlation with uptake and usage of in-home telemonitoring.

3. If there is a reduction in unplanned hospitalisations for intervention group participants. This may be indicated by, but not limited to, factors such as: reduction in the number of unplanned hospital admissions within the cohort reduction in emergency admissions.

4. If there is increased health workforce productivity. This may be indicated by, but not limited to, factors such as:


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an increase in health workforce productivity between GPs and other healthcare service providers

more efficient use of GP resources and time with greater attention being directed to those with more complex health needs rather than routine monitoring.

5. If broadband optimises opportunities for veteran healthcare. This may be indicated by, but not limited to, factors such as: veterans report in-home telemonitoring equipment is easy to manage, fast and

facilitating positive outcomes for themselves and their carers, e.g. increased speed of diagnosis, increased ability to respond to any change in condition, greater convenience through reduced travel time and costs in relation to visits to their primary health provider for routine monitoring or review of healthcare plans, increased control over health choices, and improved wellbeing

the appropriateness of various broadband technologies, such as NBN fibre, ADSL 2+, ADSL, 3G and 4G wireless, to deliver beneficial telehealth services and the relative performance of each technology in doing so.

6. Veterans have reduced pain and suffering. This may be indicated by, but not limited to, factors such as: intervention group participants report reduced pain and physical/psychological

suffering at a noticeable level mapping prescription usage patterns and measuring the changes an overall clinical view provided the GP.

7. If veterans using the in-home telemonitoring equipment remain in their home longer than those not using the telemonitoring equipment. This may be indicated by, but not limited to, factors such as: reduction in preventable admission and/or length of stay in hospital reductions in premature admission to aged care facilities present/historical rates of admissions of the comparison cohort.

8. If there is a return on investment. This may be indicated by, but not limited to, factors such as: a cost effectiveness analysis return on investment over two years and predictions over 5 and 10 years identifying potential for use in DVA’s broader treatment population identifying the factors of the trial that work well and those that could be improved.

9. If there are any systemic issues. This may be indicated by, but not limited to, factors such as systemic issues in the business process model being identified, documented and addressed.

10. If the trial was managed effectively. This may be indicated by, but not limited to, factors such as: governance established and functioning effectively the relevant key stakeholders being engaged in the trial finances managed effectively sufficient veterans engaged and maintained in the intervention group sufficient numbers of conditions are included in the intervention group to be able

to measure the changes for each condition


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sufficient veterans in the comparison cohort engaged and maintained effective stakeholder communication strategies are in place.

11. If the telemonitoring trial is suitable for further development and/or delivery to a broader cohort (scalable). This may be indicated by, but not limited to, factors such as: the veteran profile most suited to using telemonitoring services equipment suitability appropriateness of the business process model for general practices.

12. If there are improvements to be made to enhance the outcomes achieved by the trial.

13. What risks are reduced or increased by telemonitoring.

14. If there is telemonitoring technology that DVA could consider into the future to enhance veteran services.

15. To assess the unintended consequences both positive and negative that might arise from in-home telemonitoring and use the learning both within the program and more widely.


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BAPPENDIX B – SUMMARY OF COMPARABLE

TRIALSAlthough there have been numerous projects undertaken both nationally and internationally, there were two projects of direct relevance to the DVA IHT trial. An overview of findings for each of these is presented below and these findings have been drawn upon, as appropriate, for the discussion of results from the DVA trial.

B.1 WHOLE SYSTEM DEMONSTRATOR PROJECT – UKThe Whole-System Demonstrator Pilot (WSD) was undertaken in the UK and involved providing telehealth to 3,230 people with diabetes, chronic obstructive pulmonary disease or heart failure recruited from general practices between May 2008 and November 2009. A series of analyses have been produced and the main findings summarised below.1

B.1.1 CLINICAL EFFECTSFindings from a clinical perspective included that:

over the 12 months that they spent in the trial, patients allocated to receive the telehealth intervention had fewer emergency hospital admissions, they experienced an average of 0.54 emergency admissions per person, compared with 0.68 per person for control patients – a difference of around 20%

over the twelve months, 4.6% of intervention patients died, compared with 8.3% of control patients

the differences in emergency admissions and mortality were statistically significant, so were unlikely to have been caused by chance

for intervention patients, the overall costs of hospital care (including emergency admissions, elective admissions and outpatient attendances) were £188 per patient less than those for controls, although this cost difference was not found to be statistically significant

detailed estimates of the cost of the telehealth intervention have not yet been released, but will need to be offset against these cost estimates.

The report also cites some reasons for caution in interpretation of the findings, including:

although intervention patients experienced 20% fewer emergency admissions than controls, these reductions were from a low base

although this was the largest randomised trial of telehealth conducted globally, the findings relate only to three sites in England.

B.1.2 EFFECT ON HEALTH-RELATED QUALITY-OF LIFEThe study examined quality-of life using the Short Form SF-36. Around 50% of the participants completed the questionnaires and found no statistically significant improvements with quality-of-life, fear or depression.1 Kidholm K, Dinesen B, Dyrvig A, Rasmussen BS, Yderstraede KB (2014) Results from the world’s largest telemedicine project – the Whole System Demonstrator. EWMA Journal 2014 vol 14 no 1


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B.1.3 ECONOMIC EFFECTSAn economic analysis was undertaken to assess the cost-effectiveness of the project and found that the cost/patient in the telehealth group was 15% higher than the control group with the main contributing factor being the equipment and support components of telehealth. Although the differences were not found to be statistically significant, and that the costs could be reduced through greater utilisation of the equipment, the authors of the final report concluded that telehealth is not cost effective if used as an add-on to standard care

The DVA telemonitoring trial differed in that DVA clients participating in the trial also participated in the CVC Program and the clinical model was embedded in the GP practice. Thus, it is possible that the telemonitoring augmentation of CVC results in more modest changes than the findings observed in the UK study.

B.1.4 ORGANISATIONAL EFFECTSHealth workers and administrators were consulted regarding the impact on the organisation and found that the trial design (randomised) impacted on achieving the full benefits of the service. Impacts included “the possible lack of directed intervention to patients with special needs and the lack of experienced-based adjustment during the trial”.

B.1.5 BARRIERS TO PATIENTThe study investigated the reasons for declining participation and reported a number of issues, including concerns about:

the capacity to operate the equipment using equipment that implied a loss of independence and being medically sicker than

they felt the impact on health and social services disrupting existing treatment.

B.2 CSIRO AND AUSTRALIAN GOVERNMENT TELEHEALTH PILOTS PROGRAM – HOME MONITORING OF CHRONIC DISEASE TELEHEALTH TRIAL

The CSIRO trial reported significant cost savings, although it is noted that the average age of participants was 10 years younger. Table B1 summarises the features of the CSIRO trial and contrasts these features of the DVA IHT trial.


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Table B1: Key features of the DVA IHT trial and the CSIRO home monitoring trial

Trial compone

ntDVA In-home telemonitoring trial

CSIRO and Australian Government Telehealth Pilots Program – Home

monitoring of chronic disease telehealth trial

Focus/goal demonstrate a safe, effective and efficient complement to conventional health care (NBN demonstration project)

improve monitoring and management of complex chronic conditions

reduce preventable admission and enables veterans to remain at home (not RACF)

realise net budget savings in the longer term

demonstrate successful deployment of telehealth services nationally

use telehealth as an alternative cost-effective health service for chronic disease management

develop and deploy an Automated Risk Stratification system for triaging(Note – different trial models with different focus/goals)

Eligibility veteran; Gold Card Holder; eligible for CVC program; one or more of eligible chronic conditions (COPD, CAD, CHF, Diabetes); patient in a trial site practice

demographic matched controls (health and wellbeing) and DVA case matched controls (quantitative data)

chronic condition

case matched controls

Model GP practice-centred four trial sites across three states

four different models of care: hospital based chronic disease management – one site; LHD and community/ambulatory – two sites; Primary Health Network led with GP/community nursing centred care approach – two sites; Aged care focus – GP centred care approach – one site

six trial sites (revised to five) across five states

Trial length 30 months (to end 2016) 20 months (to end 2014)

Participant profile # enrolled (intervention group): 300

(147 monitoring at 30 September 2016)

mean age: 81 % male: 60%

# enrolled (intervention group): 113 average age: 71.1 % male: 65%


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Key themes from the CSIRO Health and Biosecurity report (2016) are summarised in Table B2 below2.

Table B2: Key CSIRO trial findings

CSIRO trial findings

Healthcare outcomes and impacts of telemonitoring on patients

>40% reduction in mortality (after one year) 46.3% reduction in rate of MBS expenditure (after one year) 25.5% reduction in rate of PBS expenditure (after one year) 53.2% reduction in rate of admission to hospital (after one year) 75.7% reduction in rate of length of stay (after one year)

Health economic benefits

if a critical mass of patients to achieve economies of scale were to be in the order of 10,000 patients, then 50 telemonitoring centres would be required nationally, each funded at a level of approximately $40m each – at a total cost of $2.0b. With means testing and cost sharing, the Commonwealth investment could be reduced to the order of $1b annually

if one hospital admission for a chronically ill patient, at an average cost of $6,000 could be avoided, cost savings of approximately $3b per annum could be achieved (a ROI between 2 and 3)

at the level of maturity currently in Australia, CSIRO recommends monitoring and clinical triage continues to be carried out as close to the coal face as possible to the provision of hands-on care to chronically ill patients

in order of 500,000 people aged over 65 with complex chronic conditions and multiple co-morbidities who are admitted to hospital at least once each year would benefit from at-home telemonitoring of their vital signs and from on-going clinical monitoring and triage of their health status

Impact on clinical work force availability and deployment

Clinical Care Coordinators (CCSs) generally viewed every patient record daily and tracked time spent on every patient using the CSIRO WEB portal

on average CCCs accessed the telemonitoring Clinician Web Portal twice a day and spent on average between 30 and 40 minutes per day reviewing patient data

hospital based sites of TAS and ACT logged in to the CSIRO portal on average 1.4 times per day

community based sites, CCCs were logging in overage less than once per day normal care by patients’ GP and/or community nurse is improved by the early warning of an

exacerbation provided by at home telemonitoring savings are available to patients in reducing out of pocket expenses associated with GP and

hospital visits as well as reduced travel costs and loss of income for those patients still in employment

Human factors (acceptability, usability by patients, carers, nurses, GPs and administrators)

>60% user adherence to measurement protocols (after one year) >50% user adherence to questionnaire administration (after one year) >83% user acceptance and use of telemonitoring technology (after one year) >89% of clinicians would recommend telemonitoring services to other patients (after one

2 Celler B, Vernfield M, Sparks R, Li J, Nepal S, Jang-Jaccard J, McBride S & Jayasena R (2016) Home Monitoring of Chronic Disease for Aged Care. Final Report May 2016. CSIRO Health and Biosecurity. Australian e-Health Research Centre, CSIRO.


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CSIRO trial findings

year) telemonitoring improved users’ knowledge of their condition (69.4%) and increased

awareness of symptoms to monitor (77.6%) users reported they had become more involved in monitoring their health conditions (79.6%)

and improved self-care (71.4%) because of telemonitoring most users (89.8%) indicated they would recommend telemonitoring service to others 12.2% of users felt that monitoring their vital signs every day increased their anxiety or

worries about their condition improved patient understanding of their condition and better patient self-management leads

to a reduced demand on GP and nursing services a small number of GPs were able to identify significant benefits for their patients by the early

warning system provided by the telemonitoring service that could identify an early exacerbation of patient’s condition and orchestrate an optimal response from the patient’s clinical carers to avoid unnecessary hospitalisation

Success factors for organisational change management and impact on workplace culture

strong support and leadership from health service management team and formation of strong clinical governance for the service

strong alignment of workplace culture and values with the objectives of telemonitoring including implementation of extensive training and education programs

clear ownership and engagement with patent and carers (relatives, neighbours, community nurses, or GPs)

support for telemonitoring services through automated risk stratification protocols with ability to identify with high probability, patients that are demonstrating an exacerbation of their condition and may require immediate attention to avoid unnecessary hospitalisation

GP engagement was time consuming, taking months and caused project delays and CCCs frequently reported challenges contacting patient’s GP when exacerbation of their patient’s chronic condition was becoming evident

clear governance protocols and lines of communication between CCC and patient’s care team (particularly their GP)

funding models from state and veteran jurisdictions to align with those who pay to those who benefit from the telemonitoring of chronically ill patients

Key differences between CSIRO trial3 and DVA IHT trial were that:

eligibility criteria excluded any psychiatric conditions from CSIRO trial – veteran’s as a cohort tend to experience higher rates of certain psychiatric conditions such as PTSD and anxiety/depression

the cohort for CSIRO – 67% male; 33% female (average age of 71.1 ± 8.7 at commencement)

different surveys were used.



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The CSIRO study reported reasons for trial participants withdrawing after consent but before deployment of monitoring equipment included: 4

GP/Specialist refused consent (n=2) participant was not contactable to arrange telemonitoring equipment deployment

(n=5) participant could not successfully connect to the internet via NBN or ADSL (n=8) living environment was unsuitable for telemonitoring equipment deployment (n=4)

such as limited space change in personal circumstances (n=8) including deteriorating health, family care

responsibilities and loss of interest due to unforeseen extended waiting times.

Reasons for test participants withdrawing from trial after telemonitoring equipment deployment as cited in CSIRO study:

no longer interested/ lack of motivation or commitment (n=4) do not feel the benefits from the intervention (n=6) change in circumstances such as no longer meeting inclusion criteria, deterioration of

health, difficulty using telemonitoring equipment (n=10) competing life demands including work, family and stress (n=4) logistical reasons (n=5).

Return on investment (GP consultations/hospital visits)The CSIRO study indicated that return on investment from a national initiative would be approximately 5:1 by reducing demand on hospital inpatient and outpatient services, reduced visits to GPs, reduced visits from community nurses and an overall reduced demand on increasingly scarce clinical resources. This could be achieved by improvements in patient self-management, high levels of patient satisfaction and a perceived improvement in patient quality of life and health outcomes. This is summarised in Table B3.



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Table B3: Estimating potential ROI of telemonitoring5

Item Cost

Capital cost averaging $1,324 amortised over 4 years at 7% interest $35/ monthInternet costs (3/4G data costs, 10MB monthly plan) $5/ monthHosting, maintenance and Web services @ $70/ month $70/ monthNurse coordination (100 patients/ clinical care coordinator, $4/day/ patient) $120/ monthTotal $230/ monthEstimate of annual cost ($2,760 pa)Savings in MBS and PBS costs (approximate, from CSIRO trial data) $1,000 paReduced LOS, averaging 7.5 bed days @ $2,051/ day $15,383 paReduced demand on community nurses (Reduction of one visit/ week @ $60/ visit)

$2,880 pa

Estimate of annual savings ($19,263 pa)Return on investment (ROI) 5.98Without involvement of community nurse 4.9

*Based on 48 weeks a year, 9-5pm monitoring; monitoring 3 x vital signs + clinical questionnaires; assumes normal care is GP with/without Community nurse; cost of bed day = $2051 (Queensland Health’s 2012 – 2013 Average patient cost – hospital and health acre activity based costing collection)

The authors of the CSIRO study suggested that greater cooperation between State and Federal funding agencies would be required to establish policy frameworks and targeted funding models to scale up telehealth services nationally according to their experience. System level organisational changes and alterations in local governance and workplace cultures would also require active promotion as the introduction of new models of care tended to succeed or fail at the operational and patient coal-face.

Social value: Relationship and peace of mindQualitative feedback as reported by the CSIRO indicated that patients have increased confidence in taking care of their own health and peace of mind that there is someone to assist them if required – this was consisted with feedback obtained through HOI’s case study, practice and patient interviews.



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CAPPENDIX C – ANALYSIS OF DMIS DATA

The following provides the full analysis of data extracted from DVA’s Departmental Management Information System (DMIS) database for all three cohorts: Gold Card Holders (GCH), Coordinated Veterans’ Care (CVC) and the In-Home Telemonitoring (IHT)-the trial participant group. Data is provided for the period 1 July 2014 to 30 September 2016 and contrasts this against the reported baseline position which covers the period 1 July 2012 to 30 June 2014. More specifically this includes:

1. The baseline data for the period 1 July 2012 to 30 June 2014 (the period representing two complete financial years before the trial began) which profiled GCH and CVC clients in the trial regions, as well as IHT trial participants.

2. Comparative data from DMIS for the trial period 1 July 2014 to 30 September 2016. Trial participants (active and withdrawn) included in the data analysis are those who participated in the trial for a minimum of 18 months (with buffer of 10 days) in the period 1 July 2014 to 30 September 2016. Also note that some public hospital data is only available to 30 June 2016, and this is specified where appropriate.

3. A comparison has been made between those participants who joined CVC concurrently with the trial (start date on CVC is within three months of start date on the trial) and those who have been on CVC for a period of time before commencing on the trial (start date on CVC is three months or more than the start date on the trial). In the tables provided in this appendix these two cohorts have been designated as: IHT (new CVC) – participant joined CVC and the trial concurrently IHT (pre CVC) – participant on CVC prior to commencing on the trial.

Observations of significance have been bolded in the tables presented and such observations are further discussed in the main report.

Special notes:

Public hospital data for the trial period has been made available for 1 July 2014 to 30 June 2016 only. This limitation has been incorporated into the analysis through standardisation and per quarter analysis enabling direct comparison of data.

This analysis differs to previous (interim) reports in that data has been standardised to take into account: the difference between the trial period (27 months) and baseline period (24 months), and where relevant the difference between available data (i.e. public hospital data), to enable direct comparison. In addition, the standardisation method supports comparison of participants with varying lengths of active trial participation. For this reason, analysis and trends may be presented based on increased granularity through quarterly analysis. Per quarter normalisation analysis is indicated in each table where relevant.

Standardising by quarter has no impact on the sample size for each cohort. Classifications are static based on current status. Dynamic sample size has been enabled to account for client deaths only (i.e. in any given analysis period (tables or timeseries charts), per-client time scaling has been used to account for death if applicable, i.e.: if the client died during the time period in question).


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C.1 HOSPITAL ADMISSIONSThis section provides an analysis of all hospital episodes including single day and overnight. Note: Those designated as group ‘IHT (new CVC)’ are those Telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as group ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial.

Table C1: Percentage change in total (public and private) hospital episodes and costs (based on quarterly analysis)

Total hospital episodes and costs% Change for each cohort between baseline and trial periods

GCH CVC IHT

Total hospital episodes (per quarter) 21.0% 13.1% 29.3%% of cohort who had a hospital episode 18.5% 16.9% -2.9%Total hospital episode cost (per quarter) 23.4% 27.8% 15.1%Mean cost per client (per quarter) 53.9% 43.2% 16.8%Mean episodes per client (per quarter) 28.7% 17.2% 31.1%Proportion episodes overnight (mean) 0.9% 11.0% -8.5%Average length of stay (days) 7.2% 15.7% 7.8%Average length of stay (days) [excl. same day]

7.3% 7.4% 17.8%


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Table C2: Change in total (public and private) hospital episodes and costs (based on quarterly analysis)

Total hospital episodes and costsGCH CVC IHT

(n = 2568) (n = 3043) (n = 1411) (n = 1650) (n = 138) (n = 134)Baseline Trial Baseline Trial Baseline Trial

Total hospital episodes (per quarter) 1,288 1,558 727 822 72 93% of cohort who had a hospital episode (per quarter)

44.3% 52.5% 54.0% 63.2% 82.6% 80.2%

Total hospital episode cost (per quarter) $6,278,618 $7,748,543 $3,543,591 $4,529,230 $324,784 $373,783Mean cost per client (per quarter) $2,552 $3,928 $2,508 $3,591 $2,406 $2,811

95% CI [2393, 2711]

[3502, 4355]

[2320, 2696]

[3260, 3922]

[1938, 2874]

[2244, 3378]

Mean episodes per client 0.5 0.7 0.5 0.6 0.5 0.795% CI [0.5, 0.6] [0.6, 0.7] [0.4, 0.6] [0.5, 0.7] [0.4, 0.6] [0.5, 0.9]Proportion episodes overnight (mean) 51% 51% 52% 58% 47% 43%95% CI [50, 52] [50, 52] [51, 53] [57, 59] [43, 51] [39, 47]Average length of stay (days) 4.3 4.6 4.3 5.0 3.3 3.695% CI [4.2, 4.5] [4.5, 4.8] [4.0, 4.7] [4.8, 5.2] [2.9, 3.8] [3.2, 4.0]Average length of stay (days) [excl. same day]

7.6 8.1 7.4 7.9 6.0 7.0

95% CI [7.3, 7.8] [7.9, 8.4] [6.7, 8.0] [7.6, 8.2] [5.1, 6.8] [6.2, 7.8]


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Table C3: Change in total (public and private) hospital episodes and costs within the trial participant group

Total hospital episodes and costsIHT new CVC IHT pre CVC

(n = 50) (n = 51) (n = 88) (n = 83)Baseline Trial Baseline Trial

Total hospital episodes (per quarter) 24 29 48 65% of cohort who had a hospital episode (per quarter) 84.7% 86.4% 81.5% 76.9%Total hospital episode Cost (per quarter) $142,413 $107,068 $182,371 $266,715Mean cost per client (per quarter) $2,848 $2,121 $2,146 $3,23595% CI [1860, 3836] [1399, 2843] [1671, 2620] [2438, 4032]Mean episodes per client 0.5 0.6 0.6 0.895% CI [0.4, 0.6] [0.4, 0.8] [0.4, 0.7] [0.5, 1.1]Proportion episodes overnight (mean) 53% 44% 44% 43%95% CI [45, 60] [37, 50] [39, 49] [38, 47]Average length of stay (days) 4.3 3.0 2.8 3.995% CI [3.3, 5.3] [2.5, 3.4] [2.4, 3.2] [3.3, 4.4]Average length of stay (days) [excl. same day] 7.3 5.5 5.2 7.795% CI [5.5, 9.1] [4.8, 6.3] [4.4, 5.9] [6.6, 8.8]


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Table C4: Change in total (public and private) hospital episodes by region, including proportion of all regions

Hospital episodes by region (per

quarter)

GCH CVC IHT(n =

2461)(n =

3043) % Change

(n = 1413)

(n = 1650) % Change

(n = 135) (n = 134) %

ChangeBaseline Trial Baseline Trial Baseline Trial

Bayside466 537 15.3% 168 194 15.5% 10 14 43.4%36% 34% -4.7% 23% 24% 2.2% 14% 15% 10.9%

Darling Downs246 287 16.5% 94 103 10.3% 15 15 -0.1%19% 18% -3.7% 13% 13% -2.5% 20% 16% -22.8%

New England111 160 44.4% 71 77 8.1% 5 6 22.9%9% 10% 19.3% 10% 9% -4.4% 7% 6% -4.9%

North Coast465 574 23.5% 394 447 13.6% 43 59 36.9%36% 37% 2.1% 54% 54% 0.5% 59% 63% 5.9%

Total 1,288 1,558 21.0% 727 822 13.1% 72 93 29.3%


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Table C5: Change in total (public and private) hospital episodes by region within the trial participant group

Hospital episodes by region (per

quarter)

IHT new CVC IHT pre CVC(n = 50) (n = 51) %

Change(n = 85) (n = 83)

% ChangeBaseline Trial Baseline Trial

Bayside3 5 69.3% 7 9 32.5%

12% 17% 43.0% 14% 14% -1.7%

Darling Downs9 6 -33.9% 6 9 56.6%

38% 21% -44.1% 11% 13% 16.2%

New England2 1 -8.5% 3 5 36.8%

6% 5% -22.7% 7% 7% 1.5%

North Coast11 16 53.9% 32 42 31.3%

44% 57% 30.0% 67% 65% -2.6%Total 24 29 18.4% 48 65 34.8%

Table C6: Percentage change in private hospital episodes and costs

Private hospital episodes and costs% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Total hospital episodes (per quarter) 2.4% 6.9% 41.2% 30.8% 45.8%Total hospital episode cost (per quarter) 8.8% 29.2% 14.7% -31.1% 50.6%Mean cost per client (per quarter) 39.7% 60.2% 12.5% -30.0% 44.7%Mean episodes per client (per quarter) 23.8% 20.8% 37.6% 32.0% 39.3%Proportion episodes overnight (mean) 1.0% 9.7% -13.6% -19.3% -10.5%Average length of stay (days) 9.3% 24.3% 2.8% -37.4% 29.9%Average length of stay (days) [Overnight only] 9.7% 17.9% 17.2% -32.1% 52.9%

Table C7: Change in private hospital episodes and costs

Private hospital episodes and costs GCH CVC IHT


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Total hospital episodes (per quarter) 965 988 522 559 58 81Total hospital episode cost (per quarter) $4,326,144 $4,706,330 $2,304,186 $2,976,303 $244,523 $280,557Mean cost per client (per quarter) $2,038 $2,847 $1,846 $2,958 $2,090 $2,35295% CI [1920, 2157] [2647, 3047] [1716, 1977] [2639, 3277] [1596, 2584] [1833, 2870]Mean episodes per client (per quarter) 0.5 0.6 0.4 0.5 0.5 0.795% CI [0.4, 0.5] [0.5, 0.6] [0.4, 0.5] [0.4, 0.6] [0.4, 0.6] [0.4, 0.9]Proportion episodes overnight (mean) 47% 47% 48% 52% 40% 35%95% CI [45, 48] [46, 48] [46, 49] [51, 54] [36, 45] [31, 38]Average length of stay (days) 4.1 4.5 4.0 5.0 3.2 3.395% CI [4.0, 4.3] [4.3, 4.7] [3.8, 4.2] [4.7, 5.2] [2.7, 3.7] [2.9, 3.7]Average length of stay (days) [excl. Same Day]

7.7 8.5 7.3 8.6 6.4 7.5

95% CI [7.4, 8.0] [8.2, 8.8] [6.9, 7.6] [8.2, 8.9] [5.2, 7.6] [6.6, 8.4]


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Table C8: Change in private hospital episodes and costs – Pre CVC contrasted against new to CVC

Private hospital episodes and costsIHT (new CVC) IHT (pre CVC)


Total hospital episodes (per quarter) 18 23 40 58Total hospital episode cost (per quarter) $107,316 $73,952 $137,206 $206,605Mean cost per client (per quarter) $2,439 $1,707 $1,880 $2,72095% CI [1333, 3545] [1126, 2287] [1432, 2327] [1979, 3462]Mean episodes per client (per quarter) 0.4 0.5 0.5 0.895% CI [0.3, 0.5] [0.3, 0.8] [0.4, 0.7] [0.4, 1.2]Proportion episodes overnight (mean) 45% 36% 38% 34%95% CI [36, 53] [29, 43] [33, 44] [30, 38]Average length of stay (days) 4.3 2.7 2.7 3.595% CI [2.9, 5.7] [2.2, 3.1] [2.2, 3.1] [3.0, 4.0]Average length of stay (days) [excl. Same Day] 8.4 5.7 5.4 8.395% CI [5.5, 11.2] [4.8, 6.6] [4.4, 6.4] [7.0, 9.5]


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Table C9: Change in private hospital episodes by region, including proportion of all regions

Private hospital episodes by region (per

quarter)

GCH CVC IHT(n =

2123)(n =

2184) % Change

(n = 1248)

(n = 1306) %

Change

(n = 117)

(n = 121)%

ChangeBaseline Trial Baseline Trial Baseline Trial

Bayside412 422 2.4% 145 150 2.9% 9 12 32.4%43% 43% 0.0% 28% 27% -3.8% 16% 15% -6.2%

Darling Downs205 219 7.1% 77 78 1.7% 10 11 2.6%21% 22% 4.6% 15% 14% -4.9% 18% 13% -27.4%

New England54 55 1.4% 40 40 1.2% 3 4 15.0%6% 6% -1.0% 8% 7% -5.3% 6% 5% -18.6%

North Coast294 292 -0.8% 261 291 11.6% 35 55 57.6%30% 30% -3.1% 50% 52% 4.3% 60% 67% 11.6%

Total 965 988 2.4% 522 559 6.9% 58 81 41.2%Table C10: Percentage change in public hospital episodes and costs

Public hospital episodes and costs% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Total hospital episodes (per quarter) 78.6% 35.4% 24.0% -3.9% 47.4%Total hospital episode cost (per quarter) 54.9% 25.0% 10.8% -14.2% 30.2%Mean cost per client (per quarter) 76.6% 18.0% -11.5% -23.4% -2.7%Mean episodes per client (per quarter) 55.3% 20.0% -0.8% -13.7% 10.1%Proportion episodes overnight (mean) -8.5% 6.4% -15.7% -12.1% -17.5%Average length of stay (days) -3.1% -5.8% 0.8% -11.8% 13.0%Average length of stay (days) [excl. same day] 4.3% -11.2% 15.8% -3.1% 33.6%


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Table C11: Change in public hospital episodes and costs

Public hospital episodes and costsGCH CVC IHT


Total hospital episodes (per quarter) 323 577 204 276 15 18Total hospital episode cost (per quarter) $1,952,475 $3,023,799 $1,239,405 $1,549,325 $80,261 $88,928Mean cost per client (per quarter) $1,923 $3,397 $1,990 $2,347 $1,514 $1,34095% CI [1682, 2165] [2703, 4091] [1688, 2292] [2049, 2645] [1067, 1962] [948, 1732]Mean episodes per client (per quarter) 0.3 0.5 0.3 0.4 0.3 0.395% CI [0.2, 0.4] [0.4, 0.6] [0.2, 0.5] [0.3, 0.5] [0.2, 0.3] [0.2, 0.3]Proportion episodes overnight (mean) 63% 58% 63% 67% 73% 62%95% CI [61, 65] [56, 59] [61, 66] [66, 69] [65, 81] [54, 70]Average length of stay (days) 4.9 4.8 5.2 4.9 3.9 3.995% CI [4.5, 5.4] [4.5, 5.0] [4.0, 6.4] [4.6, 5.1] [3.3, 4.5] [3.2, 4.7]Average length of stay (days) [excl. same day]

7.2 7.5 7.6 6.7 5.0 5.8

95% CI [6.6, 7.9] [7.1, 8.0] [5.7, 9.4] [6.4, 7.1] [4.3, 5.7] [4.8, 6.7]


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Table C12: Change in public hospital episodes and costs, by region (including proportion of all regions)

Public hospital episodes by region (per

quarter)

GCH CVC IHT(n =

1016)(n =

1711) % Change

(n = 623) (n = 902) % Change

(n = 53) (n = 67) % Change

Baseline Trial Baseline Trial Baseline Trial

Bayside55 126 130.2% 22 52 131.0% 1 2 259.5%

17% 22% 28.9% 11% 19% 70.6% 4% 13% 190.0%

Darling Downs41 65 57.5% 17 25 47.9% 4 4 -17.3%

13% 11% -11.8% 8% 9% 9.3% 30% 20% -33.3%

New England56 102 81.8% 32 39 22.5% 2 2 58.1%

17% 18% 1.8% 15% 14% -9.5% 10% 13% 27.5%

North Coast171 283 66.1% 133 161 20.8% 8 10 21.7%53% 49% -7.0% 65% 58% -10.8% 55% 54% -1.8%

Total 323 577 78.6% 204 276 35.4% 15 18 24.0%


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Table C13: Percentage change in public hospital episodes by age group, per quarter

Public hospital episodes (per quarter)% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Under 70 years -32.2% -21.6% -53.9% -63.7% -0.1%Proportion of total (under 70 years) -62.0% -42.1% -62.8% -62.2% -32.3%70-79 years 48.5% -13.3% 111.5% 99.7% 119.7%Proportion of total (70-79 years) -16.8% -35.9% 70.6% 107.8% 49.0%80-89 years 77.9% -30.6% 30.9% 13.5% 47.6%Proportion of total (80-89 years) -0.3% -48.7% 5.6% 18.1% 0.1%90 years and over 186.1% 251.6% 32.0% 99.7% 26.7%Proportion of total (90 years and over) 60.2% 159.7% 6.4% 107.8% -14.0%Total 78.6% 35.4% 24.0% -3.9% 47.4%


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Table C14: Change in public hospital episodes by age group, per quarter

Public hospital episodes (per quarter)GCH CVC IHT


Under 70 years 54 37 19 15 3 1Proportion of total (under 70 years) 17% 6% 9% 5% 22% 8%70-79 years 86 128 24 21 2 4Proportion of total (70-79 years) 27% 22% 12% 7% 15% 25%80-89 years 102 182 116 81 6 7Proportion of total (80-89 years) 32% 32% 57% 29% 39% 41%90 years and over 80 230 46 161 4 5Proportion of total (90 years and over) 25% 40% 22% 58% 24% 26%Total 323 577 204 276 15 18


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Table C15: Change in public hospital episodes by age group, per quarter for trial sub groups

Public hospital episodes (per quarter)IHT (new CVC) IHT (pre CVC)


Under 70 years 3 1 1 0Proportion of total (under 70 years) 42% 16% 6% 4%70-79 years 1 2 1 3Proportion of total (70-79 years) 13% 27% 16% 24%80-89 years 3 3 3 4Proportion of total (80-89 years) 42% 49% 37% 37%90 years and over 0 0 3 4Proportion of total (90 years and over) 4% 8% 41% 35%Total 7 6 8 12


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Table C16: Percentage change in public hospital episodes by number of conditions, per quarter

Public hospital episodes (per quarter)% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)1 condition 95.7% 54.1% 96.6% 33.2% 152.6%Proportion of total (1 condition) 9.6% 13.9% 58.6% 38.6% 71.3%2 conditions 143.3% 28.3% -15.4% 3.7% -30.4%Proportion of total (2 conditions) 36.3% -5.2% -31.7% 7.9% -52.8%3 conditions 3.4% 24.0% 93.1% -62.6% 270.9%Proportion of total (3 conditions) -42.1% -8.4% 55.7% -61.0% 151.6%4 conditions 34.2% 2.9% -80.0% -75.0% -83.4%Proportion of total (4 conditions) -24.8% -24.0% -83.9% -74.0% -88.7%Total 78.6% 35.4% 24.0% -3.9% 47.4%

Note: No public hospital episodes (per quarter) for IHT pre CVC group with four conditions at baseline or through trial.


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Table C17: Change in public hospital episodes by number of conditions, per quarter

Public hospital episodes (per quarter)GCH CVC IHT


1 condition 125 245 63 98 4 8Proportion of total (1 condition) 39% 43% 31% 35% 28% 44%2 conditions 77 188 87 112 7 6Proportion of total (2 conditions) 24% 33% 43% 41% 51% 35%3 conditions 68 70 19 23 2 4Proportion of total (3 conditions) 21% 12% 9% 8% 13% 20%4 conditions 8 11 8 8 1 0Proportion of total (4 conditions) 2% 2% 4% 3% 9% 1%Total 323 577 204 276 15 18


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Table C18: Change in public hospital episodes by number of conditions, per quarter for trial sub groups

Public hospital episodes (per quarter)IHT (new CVC) IHT (pre CVC)


1 condition 2 2 2 5Proportion of total (1 condition) 28% 39% 27% 46%2 conditions 3 3 4 3Proportion of total (2 conditions) 49% 53% 52% 25%3 conditions 1 0 1 3Proportion of total (3 conditions) 15% 6% 11% 28%4 conditions 1 0 1 0Proportion of total (4 conditions) 8% 2% 10% 1%Total 7 6 8 12

Scatterplots and timeseries trend graphs of hospital episodes and costs

Analysis was undertaken to determine changes in the mean between baseline and trial periods based on hospital admissions and costs by age, number of conditions and gender. The following scatterplots and timeseries trend graphs were produced. There were no significant differences across cohorts. They do show however, (especially for GCH, CVC) increasing costs as clients get older and have more conditions, as one would expect. These charts also accentuate that overall data variability is very high and that IHT sample sizes are small, suggesting detection of trial effects across means is unlikely to be detected without a significant difference in means.

Notes for interpretation:

1. There were no significant differences across cohorts, this includes for public hospitals only, and total hospital (public and private) episodes and costs.

2. Scatterplots show, (especially for GCH, CVC control groups) increasing costs as clients get older and have more conditions, as one would expect. These charts also accentuate that overall data variability is very high in the IHT group, and that IHT sample sizes are small, suggesting trial effects compared to control groups is unlikely to be detected without a significant difference in means.

3. Shaded areas around the linear regression lines are 95% confidence intervals on the linear regression.Appendices to Final reportAugust 2017

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4. To give useful visual resolution on these charts, the y axis values have been truncated at the values indicated on the chart (visually only, all of the data was used for the linear regression line calculations). Again, this is a feature of this data set, i.e. there are small number of clients with much higher costs than the average.

5. Many clients have multiple conditions, e.g. both COPD and CHF, so confounding impacts of co-morbidities is expected. Note that a multi-factor statistical model could potentially account for this confounding, but has not been used here.

6. There is no obvious seasonality in hospital (or GP) episodes or costs.7. There were no statistically significant differences identified between the means (for hospital episodes or costs per participant) within

the trial group (from baseline to trial) and from new CVC and pre CVC trial subgroups (baseline to trial).Figure C1: Hospital (public and private) episode per client (per quarter) by age, cohort and gender for the trial period


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Figure C2: Hospital (public and private) episode cost per client (per quarter) by age, cohort and gender for the trial period

Figure C3: Hospital (public and private) episode per client (per quarter) by number of conditions, cohort and gender for the trial period


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Figure C4: Hospital (public and private) episode cost per client (per quarter) by number of conditions, cohort and gender for the trial period

Figure C5: Hospital (public only) episode per client (per quarter) by age, cohort and gender for the trial period


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Figure C6: Hospital (public only) episode cost per client (per quarter) by age, cohort and gender for the trial period

Figure C7: Hospital (public only) episode per client (per quarter) by number of conditions, cohort and gender for the trial period


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Figure C8: Hospital (public only) episode cost per client (per quarter) by number of conditions, cohort and gender for the trial period

Figure C9: Hospital (public only) episode per client (per quarter) over time from baseline to end of trial period, by quarter


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Figure C10: Hospital (private only) episode per client (per quarter) over time from baseline to end of trial period, by quarter

Figure C11: Total hospital (public and private) episode per client (per quarter) over time from baseline to end of trial period, by quarter


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Figure C12: Public hospital episode per client (per quarter) over time from baseline to end of trial period, by quarter for GCH control group

Figure C13: Public hospital episode per client (per quarter) over time from baseline to end of trial period, by quarter for CVC control group


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Figure C14: Public hospital episode per client (per quarter) over time from baseline to end of trial period, by quarter for IHT participant group


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C.2 GP SERVICESThe following section provides an analysis of all GP consultations. Note: Those designated as group ‘IHT (new CVC)’ are those Telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as group ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial.

Table C19: Percentage change in the number, length and cost of GP consultations

Number, length and cost of GP consultations% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Level A Consultations (per quarter) -10.3% -0.4% 16.0% 3.1% 19.4%Level B Consultations (per quarter) -14.4% -8.6% -3.3% -1.6% -4.1%Level C Consultations (per quarter) -4.5% 5.4% 18.3% 10.4% 23.5%Level D Consultations (per quarter) 8.7% 28.0% 6.2% 1.4% 8.2%Total of Level A-D Consultations (per quarter) -12.2% -4.9% 1.7% 1.1% 2.0%Overall cost (per quarter) 38.2% 31.7% 10.2% 8.1% 11.2%Average cost per consultation 14.5% 14.6% 6.8% 5.1% 7.7%Average consultations per client (per quarter) 23.1% 15.7% 3.1% 2.9% 3.2%Average cost per client (per quarter) 40.9% 32.6% 10.2% 8.1% 11.2%

Level A Consultation: No time requirements: Professional attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.Level B Consultation: No time requirements: Professional attendance involving taking a selective history, examination of the patient with implementation of a management plan in relation to one or more problems OR a professional attendance of less than 20 minutes duration involving components of a service to which the Level C descriptor applies.Level C Consultation: Minimum of 20 minutes: Professional attendance involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems, and lasting at least 20 minutes, OR a professional attendance of less than 40 minutes duration involving components of a service to which the level D descriptor applies.Level D Consultation: Minimum of 40 minutes: Professional attendance involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or


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more complex problems, and lasting at least 40 minutes, OR a professional attendance of at least 40 minutes duration for implementation of a management plan.

Table C20: Change in the number, length and cost of GP consultations

Number, length and cost of GP consultations

GCH CVC IHT(n = 5759) (n = 5651) (n = 2611) (n = 2592) (n = 167) (n = 167)Baseline Trial Baseline Trial Baseline Trial

Level A consultations (per quarter)(% of all consultations)

1,081 970 453 451 44 515% 5% 4% 5% 6% 7%

Level B consultations (per quarter)(% of all consultations)

16,776 14,365 7,803 7,130 515 49877% 76% 75% 72% 75% 72%

Level C consultations (per quarter)(% of all consultations)

3,430 3,275 1,960 2,066 116 13716% 17% 19% 21% 17% 20%

Level D consultations (per quarter)(% of all consultations)

375 407 204 261 9 92% 2% 2% 3% 1% 1%

Total of Level A-D consultations (per quarter)

21,663 19,017 10,421 9,908 684 696

Overall cost (per quarter) $1,194,407 $1,651,020 $545,025 $717,537 $33,293 $36,683Average cost per consultation $55.12 $63.10 $52.30 $59.93 $48.65 $51.98Average consultations per client (per quarter)

3.76 4.63 3.99 4.62 4.10 4.23

95% CI [3.7, 3.8] [4.5, 4.8] [3.9, 4.1] [4.5, 4.8] [3.7, 4.5] [3.8, 4.7]Average cost per client (per quarter) $207 $292 $209 $277 $199 $22095% CI [203, 212] [282, 303] [203, 214] [265, 288] [181, 218] [197, 243]

Table C21: Change in the number, length and cost of GP consultations - Pre CVC contrasted against new to CVC

Number, length and cost of GP IHT (new CVC) IHT (pre CVC)


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consultations(n = 59) (n = 59) (n = 108) (n = 108)Baseline Trial Baseline Trial

Level A consultations (per quarter)(% of all consultations)

9 10 35 424% 4% 8% 9%

Level B consultations (per quarter)(% of all consultations)

160 157 356 34174% 72% 76% 72%

Level C consultations (per quarter)(% of all consultations)

46 50 70 8721% 23% 15% 18%

Level D consultations (per quarter)(% of all consultations)

3 3 6 71% 1% 1% 1%

Total of Level A-D consultations (per quarter)

217 219 467 476

Overall cost (per quarter) $11,053 $11,949 $22,240 $24,734Average cost per consultation $50.92 $53.51 $47.60 $51.27Average consultations per client (per quarter)

3.68 3.78 4.33 4.47

95% CI [3.1, 4.2] [3.1, 4.4] [3.8, 4.8] [3.9, 5.1]Average cost per client (per quarter) $187 $203 $206 $22995% CI [154, 220] [164, 241] [183, 229] [200, 258]


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Table C22: Percentage change in chronic disease management (CDM) consultations

GP consultations for chronic disease management

% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)

Number CDM consultations (per quarter) 3.5% 5.4% 15.6% 30.3% 12.0%Total CDM cost (per quarter) 5.6% 6.9% 20.6% 44.7% 15.1%Average number consultations per CDM Client (per quarter)

10.1% 3.9% 2.0% 3.2% 2.4%

Average cost per CDM client (per quarter) 12.4% 5.4% 6.5% 14.5% 5.2%

Table C23: Change in chronic disease management consultations



Number CDM consultations (per quarter) 355 368 313 330 15 18Total CDM cost (per quarter) $88,104 $93,051 $81,826 $87,508 $4,038 $4,870Average number consults per CDM client (per quarter)

0.18 0.20 0.19 0.20 0.18 0.19

95% CI [0.18, 0.18] [0.19, 0.20] [0.19, 0.20] [0.20, 0.21] [0.17, 0.20] [0.17, 0.20]Average cost per CDM client (per quarter) $44 $50 $51 $53 $49 $5295% CI [43, 45] [48, 51] [49, 52] [52, 55] [44, 53] [47, 56]


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Table C24: Change in chronic disease management consultations - Pre CVC contrasted against new to CVC


IHT (new CVC) IHT (pre CVC)(n = 19) (n = 24) (n = 64) (n = 70)Baseline Trial Baseline Trial

Number CDM consultations (per quarter) 3 4 12 14Total CDM cost (per quarter) $753 $1,090 $3,285 $3,780Average number consults per CDM client (per quarter)

0.16 0.16 0.19 0.20

95% CI [0.13, 0.19] [0.14, 0.19] [0.18, 0.21] [0.18, 0.21]Average cost per CDM client (per quarter) $40 $45 $51 $5495% CI [30, 50] [37, 54] [46, 57] [49, 59]


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Table C25: Percentage change in GP consultations and costs by region

Number and cost of GP consultations by region (per

quarter)


GCH CVC IHT IHT (new CVC) IHT (pre CVC)Bayside Num GP consultations -13.3% -6.7% 18.5% 3.4% 27.4%

Total cost -6.3% 3.8% 32.1% 20.1% 40.1%Mean cost per consultation

8.1% 11.2% 11.5% 16.2% 10.0%

Mean cost per client 38.2% 34.4% 33.7% 20.1% 42.8%Darling Downs

Num GP consultations -10.2% -3.4% -7.4% -16.1% -3.8%Total cost -2.3% 7.5% 1.1% -17.2% 7.4%Mean cost per consultation

8.8% 11.2% 9.3% -1.2% 11.7%

Mean cost per client 40.2% 42.2% 3.8% -13.8% 14.6%New England

Num GP consultations -7.9% -4.5% 4.4% -10.7% 11.7%Total cost -1.4% 6.2% 6.9% -6.9% 12.9%Mean cost per consultation

7.0% 11.2% 2.4% 4.2% 1.1%

Mean cost per client 51.0% 52.2% 6.9% -6.9% 12.9%North Coast Num GP consultations -13.6% -4.6% -0.5% 10.4% -5.0%


6.6% 8.4% 4.8% 3.8% 5.2%

Mean cost per client 40.6% 25.4% 5.4% 16.9% 0.6%Total Num GP consultations -12.2% -4.9% 1.7% 1.1% 2.0%


7.5% 9.7% 6.9% 5.0% 7.9%

Mean cost per client 40.9% 32.6% 10.2% 8.1% 11.2%


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Table C26: Change in GP consultations and costs by region


quarter)


Bayside Num GP consultations 7,184 6,228 2,514 2,346 122 144Total cost $408,674 $382,870 $140,340 $145,651 $5,941 $7,847Mean cost per consultation

$57 $61 $56 $62 $49 $54

Mean cost per client $214 $295 $217 $292 $175 $21495% CI [207, 221] [281, 310] [207, 228] [274, 310] [139, 210] [207, 221]

Darling Downs

Num GP consultations 3,854 3,460 1,590 1,536 152 140Total cost $209,219 $204,443 $82,935 $89,162 $7,474 $7,560Mean cost per consultation

$54 $59 $52 $58 $49 $54


New England

Num GP consultations 2,587 2,384 970 926 52 54Total cost $138,608 $136,646 $47,812 $50,771 $2,482 $2,655Mean cost per consultation

$54 $57 $49 $55 $48 $49


North Coast

Num GP consultations 8,038 6,945 5,347 5,100 360 358Total cost $437,434 $402,830 $273,855 $283,039 $17,395 $18,132Mean cost per consultation

$54 $58 $51 $55 $48 $51



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quarter)


Total Num GP consultations 21,663 19,017 10,421 9,908 684 696Total cost 1,193,935 1,126,790 544,941 568,623 33,293 36,193Mean cost per consultation

$55 $59 $52 $57 $49 $52


Table C27: Change in GP consultations and costs by region - Pre CVC contrasted against new to CVC

Number and cost of GP consultations by region (per quarter)


Bayside Num GP consultations 45 47 76 97Total cost $2,388 $2,869 $3,552 $4,978Mean cost per visit $53 $61 $47 $51Mean cost per client $234 $184 $221 $16995% CI [178, 289] [112, 255] [120, 322] [128, 211]

Darling Downs Num GP consultations 51 42 101 97Total cost $2,840 $2,353 $4,634 $4,978Mean cost per consultation

$56 $55 $46 $51

Mean cost per client $268 $237 $204 $27395% CI [181, 354] [104, 370] [75, 333] [184, 361]

New England Num GP consultations 17 15 35 39Total cost $747 $695 $1,735 $1,959


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Number and cost of GP consultations by region (per quarter)


Mean cost per consultation

$45 $46 $50 $50


North Coast Num GP consultations 104 115 255 243Total cost $5,077 $5,816 $12,318 $12,316Mean cost per consultation

$49 $50 $48 $51


Total Num GP consultations 217 219 467 476Total cost 11,053 11,733 22,240 24,460Mean cost per consultation

$51 $53 $48 $51



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Table C28: Percentage change in GP consultations and costs by age group

Number and cost of GP consultations by age group (per

quarter)

% Change for each cohort between baseline and trial periodsGCH CVC IHT IHT (new CVC) IHT (pre CVC)

Under 70 years Num GP consultations

-33.8% -39.3% -37.7% -45.1% -30.3%

Total cost -30.8% -36.8% -36.2% -45.1% -27.5%70-79 years Num GP

consultations23.7% 7.5% -0.3% 43.6% -21.8%

Total cost 30.4% 12.1% 3.2% 46.9% -18.6%80-89 years Num GP

consultations-37.3% -33.5% -28.1% -27.7% -28.3%

Total cost -34.3% -27.4% -22.1% -24.3% -21.0%90 years and over

Num GP consultations

7.3% 34.1% 130.0% 267.6% 110.7%

Total cost 16.4% 48.0% 156.8% 330.9% 131.3%Total Num GP

consultations-12.2% -4.9% 1.7% 1.1% 2.0%

Total cost -5.6% 4.3% 8.7% 6.2% 10.0%


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Table C29: Change in GP consultations and costs by age group


quarter)


Under 70 years


2,274 1,505 877 533 131 82

Total cost $113,868 $78,832 $45,597 $28,795 $6,501 $4,15070-79 years Num GP

consultations1,785 2,209 1,073 1,153 142 142

Total cost $89,550 $116,777 $54,677 $61,312 $6,981 $7,20280-89 years Num GP

consultations8,033 5,037 4,638 3,085 299 215

Total cost $438,304 $288,169 $238,265 $172,991 $14,548 $11,33090 years and over


9,570 10,266 3,832 5,137 112 258

Total cost $552,213 $643,013 $206,402 $305,525 $5,263 $13,512Total Num GP

consultations21,663 19,017 10,421 9,908 684 696

Total cost $1,193,935 $1,126,790 $544,941 $568,623 $33,293 $36,193


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Table C30: Change in GP consultations and costs by age group for trial sub groups


quarter)


Under 70 years Num GP consultations

66 36 65 46

Total cost $3,209 $1,762 $3,292 $2,38870-79 years Num GP

consultations47 67 95 74

Total cost $2,319 $3,407 $4,662 $3,79480-89 years Num GP


Total cost $4,854 $3,672 $9,695 $7,65890 years and over


14 51 98 207

Total cost $671 $2,892 $4,592 $10,620Total Num GP


Total cost $11,053 $11,733 $22,240 $24,460


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Table C31: Percentage change in GP consultations and costs by number of conditions

Number and cost of GP consultations by number of

conditions (per quarter)


GCH CVC IHT IHT (new CVC) IHT (pre CVC)1 condition Num GP

consultations-8.5% -2.2%

6.9% 7.0% 6.9%Total cost -1.6% 8.0% 10.5% 8.9% 11.2%

2 conditions Num GP consultations

-16.3% -8.1%-0.9% 1.3% -2.0%

Total cost -9.7% 0.0% 5.1% 7.5% 3.9%3 conditions Num GP

consultations-22.1% -8.6%

-8.7% -8.4% -8.9%Total cost -16.7% 0.4% 8.7% 3.0% 12.2%

4 conditions Num GP consultations

-34.6% -18.6%8.7% -10.0% 18.0%

Total cost -25.8% -8.8% 17.9% -17.0% 37.7%Total Num GP

consultations-12.2% -4.9% 1.7% 1.1% 2.0%

Total cost -5.6% 4.3% 8.7% 6.2% 10.0%


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Table C32: Change in GP consultations and costs by number of conditions



GCH GCH CVC CVC IHT IHT(n = 5759) (n = 5651) (n = 2611) (n = 2592) (n = 167) (n = 167)Baseline Trial Baseline Trial Baseline Trial

1 condition Num GP consultations

10,043 9,186 4,633 4,530 319 341

Total cost $541,941 $533,284 $239,088 $258,268 $15,357 $16,9732 conditions Num GP

consultations6,039 5,055 3,166 2,910 216 214


consultations2,665 2,077 1,049 959 124 113


consultations648 424 265 216 26 28

Total cost $38,117 $28,278 $15,575 $14,212 $1,217 $1,435Total Num GP

consultations21,663 19,017 10,421 9,908 684 696

Total cost $1,193,935 $1,126,790 $544,941 $568,623 $33,293 $36,193


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Table C33: Change in GP consultations and costs by number of conditions for trial sub groups




1 condition Num GP consultations 89 95 229 245

Total cost $4,577 $4,984 $10,780 $11,9892 conditions Num GP

consultations 73 74 143 140





Total cost $441 $366 $776 $1,068Total Num GP


Total cost $11,053 $11,733 $22,240 $24,460

Scatterplots and timeseries trend graphs of GP consultations and costs

Analysis was undertaken to determine changes in the mean between baseline and trial periods based on hospital admissions and costs by age, number of conditions and gender. The following scatterplots and timeseries trend graphs were produced. These charts accentuate that overall data variability is very high and that IHT sample sizes are small, suggesting detection of trial effects across means is unlikely without a significant difference in means.Notes for interpretation:1. There is no obvious seasonality in GP (or hospital) consultations or costs.2. A typical feature of this DMIS dataset is that there are a small number of clients who have very high costs (outliers); much larger

than the average, hence the spread of the distributions.


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3. The boxplots show the 10th, 25th, 50th (median), 75th and 90th percentiles of per-client consultations/costs, and also the mean consultations/costs (red squares). 90th percentile is the top whisker (note that the remaining top 10% of clients have costs higher than this – these are not visualised due to scaling for improved visual resolution in the lower values around the average).

4. The boxplots (timeseries) detail the distribution in addition to average. In some cases, there was little change in the average but some shifting in the percentiles of the distribution over time.

5. There were no statistically significant differences identified between the means (for GP episodes per client) within the trial group (from baseline to trial) and for new CVC and pre CVC trial subgroups (baseline to trial).

6. There was a statistically significant difference identified between the means (for GP costs per client) within the trial group (from baseline to trial) and for the pre CVC trial subgroup (baseline to trial), attributed to the 80 years and over group only.

Figure C15: GP consultations per client (per quarter) for the GCH control group from baseline to end of trial


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Figure C16: GP consultations per client (per quarter) for the CVC control group from baseline to end of trial

Figure C17: GP consultations per client (per quarter) for the IHT participant group from baseline to end of trial


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C.3 SPECIALIST SERVICESThe following section provides an analysis of consultations with specialists. It includes visits to all specialists and to a targeted range of specialists related to the target chronic conditions of the trial. Note: Those designated as group ‘IHT (new CVC)’ are those Telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial. Note that targeted specialties for the purpose of this analysis included cardiology, endocrinology, general medicine, geriatrics, internal medicine, ophthalmology, thoracic medicine, and vascular surgery. This approach aimed to support the evaluation of the trial’s impacts on changes to management of the four targeted chronic conditions.

Table C34: Percentage change in total specialist services consultations and costs

Specialist services consultations and costs (per quarter)

% Change for each cohort between Baseline and Trial data

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Total consultations -23.9% -4.2% 11.4% -15.3% 23.7%Total cost -23.0% -1.5% 12.7% -15.1% 25.8%Average cost per consultation 1.2% 2.8% 1.2% 0.2% 1.7%Average cost per client 33.0% 39.3% 17.2% -17.7% 35.2%


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Table C35: Change in total specialist services consultations and costs



Total consultations 10,952 8,333 5,783 5,538 345 385Total cost $1,119,077 $861,477 $591,502 $582,385 $35,962 $40,515Average cost per consultation $102 $103 $102 $105 $104 $10595% CI [102, 102] [103, 104] [102, 103] [105, 106] [102, 106] [104, 107]Average cost per client $226 $300 $244 $340 $231 $27095% CI [217, 234] [277, 323] [231, 257] [312, 367] [192, 269] [212, 329]

Table C36: Change in total specialist services consultations and costs - Pre CVC contrasted against new to CVC



Total consultations 109 92 236 292Total cost $11,544 $9,801 $24,418 $30,714Average cost per consultation $106 $106 $103 $10595% CI [103, 108] [103, 109] [101, 105] [103, 107]Average cost per client $226 $186 $233 $31495% CI [155, 298] [130, 243] [187, 278] [231, 398]

Table C37: Percentage change in use and cost of total specialist services by region

Number and cost of specialist consultations by region (per quarter)


GCH CVC IHT IHT (new CVC) IHT (pre CVC)


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Bayside Num consultations (per qtr) -27.5% -12.7% 18.2% -20.8% 40.0%Proportion -4.8% -8.9% 6.1% -6.5% 13.2%Total cost per quarter -27.0% -11.2% 17.5% -21.7% 38.6%Mean cost per consultation 1.2% 2.8% 1.2% 0.2% 1.7%

Darling Downs

Num consultations (per qtr) -16.9% -14.0% 32.2% -15.1% 55.8%Proportion 9.2% -10.2% 18.7% 0.3% 26.0%Total cost per quarter -17.0% -12.9% 40.2% -23.3% 77.5%Mean cost per consultation 1.2% 2.8% 1.2% 0.2% 1.7%

New England Num consultations (per qtr) -17.9% -20.4% 26.2% -25.4% 50.7%Proportion 7.9% -16.9% 13.3% -12.0% 21.8%Total cost per quarter -14.5% -18.3% 27.4% -24.5% 58.1%Mean cost per consultation 1.2% 2.8% 1.2% 0.2% 1.7%

North Coast Num consultations (per qtr) -23.6% 7.3% 1.7% -11.7% 7.3%Proportion 0.4% 12.1% -8.7% 4.2% -13.3%Total cost per quarter -22.1% 10.8% 2.8% -8.6% 7.6%Mean cost per consultation 1.2% 2.8% 1.2% 0.2% 1.7%

Total Num consultations (per qtr) -23.9% -4.2% 11.4% -15.3% 23.7%Proportion 0.0% 0.0% 0.0% 0.0% 0.0%Total cost per quarter -23.0% -1.5% 12.7% -15.1% 25.8%Mean cost per consultation 1.2% 2.8% 1.2% 0.2% 1.7%

Table C38: Change in use and cost of total specialist services by region

Use and cost of specialist services by region (per quarter)

GCH CVC IHT

(n = 4963) (n = 4377) (n = 2425) (n = 2312) (n = 156) (n = 153)


Bayside Num consultations 4,775 3,460 1,903 1,661 79 93


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Use and cost of specialist services by region (per quarter)

GCH CVC IHT

(n = 4963) (n = 4377) (n = 2425) (n = 2312) (n = 156) (n = 153)


Proportion 44% 42% 33% 30% 23% 24%Total cost $497,438 $362,939 $196,844 $174,804 $7,914 $9,298Mean cost per consultation $102 $103 $102 $105 $104 $10595% CI [102, 102] [103, 104] [102, 103] [105, 106] [102, 106] [104, 107]

Darling Downs

Num consultations 1,555 1,291 765 658 53 70Proportion 14% 15% 13% 12% 15% 18%Total cost $152,688 $126,732 $73,434 $63,989 $5,213 $7,309Mean cost per consultation $102 $103 $102 $105 $104 $10595% CI [102, 102] [103, 104] [102, 103] [105, 106] [102, 106] [104, 107]

New England

Num consultations 888 729 448 356 17 22Proportion 8% 9% 8% 6% 5% 6%Total cost $84,998 $72,647 $42,867 $35,040 $1,739 $2,216Mean cost per consultation $102 $103 $102 $105 $104 $10595% CI [102, 102] [103, 104] [102, 103] [105, 106] [102, 106] [104, 107]

North Coast

Num consultations 3,734 2,852 2,667 2,863 196 200Proportion 34% 34% 46% 52% 57% 52%Total cost $383,954 $299,159 $278,358 $308,552 $21,096 $21,692Mean cost per consultation $102 $103 $102 $105 $104 $10595% CI [102, 102] [103, 104] [102, 103] [105, 106] [102, 106] [104, 107]

Total

Num consultations 10,952 8,333 5,783 5,538 345 385Proportion 100% 100% 100% 100% 100% 100%Total cost $1,119,077 $861,477 $591,502 $582,385 $35,962 $40,515Mean cost per consultation $102 $103 $102 $105 $104 $10595% CI [102, 102] [103, 104] [102, 103] [105, 106] [102, 106] [104, 107]


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Table C39: Change in use and cost of total specialist services by region - Pre CVC contrasted against new to CVC

Use and cost of specialist services by region

IHT (new CVC) IHT (pre CVC)

(n = 51) (n = 53) (n = 105) (n = 100)

Baseline Trial Baseline Trial

Bayside

Num consultations 93 28 22 50Proportion 24% 26% 24% 21%Total cost $9,298 $2,768 $2,166 $5,146Mean cost per consultation

$105 $106 $106 $103

95% CI [104, 107] [103, 108] [103, 109] [101, 105]

Darling Downs


$105 $106 $106 $103

95% CI [104, 107] [103, 108] [103, 109] [101, 105]

New England

Num consultations 22 6 4 12Proportion 6% 5% 4% 5%Total cost $2,216 $647 $489 $1,092Mean cost per consultation

$105 $106 $106 $103

95% CI [104, 107] [103, 108] [103, 109] [101, 105]North Coast Num consultations 200 58 51 139

Proportion 52% 53% 55% 59%Total cost $21,692 $6,199 $5,666 $14,897Mean cost per consultation

$105 $106 $106 $103


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Use and cost of specialist services by region

IHT (new CVC) IHT (pre CVC)

(n = 51) (n = 53) (n = 105) (n = 100)

Baseline Trial Baseline Trial95% CI [104, 107] [103, 108] [103, 109] [101, 105]

Total


$105 $106 $106 $103

95% CI [104, 107] [103, 108] [103, 109] [101, 105]


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Table C40: Number and cost of all targeted specialist services

Number and cost all targeted specialist

services (per quarter)

GCH CVC IHT % Change for each cohort

Baseline Trial Baseline Trial Baseline Trial GCH CVC IHT

Num consultations 6,053 4,455 3,201 3,045 198 229 -26.4% -4.9% 15.9%Total cost $633,841 $469,301 $336,749 $327,825 $21,653 $24,889 -26.0% -2.6% 14.9%Mean cost per consultation

$105 $105 $105 $108 $109 $109 0.6% 2.3% -0.8%

95% CI [104, 105] [105, 106] [105, 106] [107, 108] [107, 112]

[107, 111]

Table C41: Number and cost of all targeted specialist services - Pre CVC contrasted against new to CVC

Number and cost all targeted specialist


IHT (new CVC) IHT (pre CVC) % Change for each cohort

Baseline Trial Baseline Trial IHT (new CVC) IHT (pre CVC)

Num consultations 55 52 143 177 -6.3% 24.4%Total cost $6,231 $5,700 $15,422 $19,189 -8.5% 24.4%Mean cost per consultation

$113 $110 $108 $108 -2.4% 0.0%

95% CI [109, 117] [106, 114] [105, 111] [106, 111]


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Table C42: Number and cost of cardiology specialist services

Number and cost of cardiology specialist




Num consultations 1,517 1,251 938 900 79 1,517 -17.6% -4.1% -4.5%Total cost $182,611 $147,795 $112,835 $107,993 $9,506 $182,611 -19.1% -4.3% -3.3%Mean cost per consultation

$120 $118 $120 $120 $120 $120 -1.8% -0.2% 1.2%

95% CI [120, 121] [117, 119] [119, 121]

[119, 121]

[117, 123]

[120, 121]

Table C43: Number and cost of cardiology specialist services - Pre CVC contrasted against new to CVC

Number and cost of cardiology specialist



Baseline Trial Baseline Trial IHT (new CVC)

IHT (pre CVC)

Num consultations 24 18 56 58 -25.3% 4.5%Total cost $2,832 $2,317 $6,674 $6,875 -18.2% 3.0%Mean cost per consultation

$119 $130 $120 $118 9.6% -1.4%

95% CI [114, 124]

[123, 138]

[116, 124]

[115, 122]


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Table C44: Number and cost of endocrinology specialist services

Number and cost of endocrinology

specialist services (per quarter)



Num consultations 359 303 236 317 17 18 -15.5% 34.5% 5.1%Total cost $41,578 $35,444 $28,297 $37,950 $1,992 $2,063 -14.8% 34.1% 3.6%Mean cost per consultation

$116 $117 $120 $120 $118 $116 0.9% -0.3% -1.5%

95% CI [115, 117]

[116, 118]

[118, 122]

[118, 121]

[112, 124]

[110, 122]

Table C45: Number and cost of endocrinology specialist services - Pre CVC contrasted against new to CVC

Number and cost of endocrinology specialist services (per quarter)



Num consultations 3 3 14 15 -7.6% 7.9%Total cost $337 $355 $1,655 $1,708 5.5% 3.2%Mean cost per consultation $112 $128 $119 $114 14.2% -4.3%95% CI [100, 125] [109, 147] [112, 126] [108, 120]


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Table C46: Number and cost of general medicine specialist services

Number and cost of general medicine specialist services

(per quarter)



Num consultations 1,079 758 382 383 19 36 -29.7% 0.1% 89.5%Total cost $125,238 $88,716 $45,196 $44,986 $2,375 $4,330 -29.2% -0.5% 82.3%Mean cost per consultation

$116 $117 $118 $118 $124 $119 0.8% -0.6% -3.8%

95% CI [115, 117] [116, 118] [116, 120] [116, 119] [117, 131] [114, 124]

Table C47: Number and cost of general medicine specialist services - Pre CVC contrasted against new to CVC

Number and cost of general medicine specialist services (per

quarter)



Num consultations 7 9 13 28 28.8% 121.7%Total cost $866 $1,061 $1,509 $3,269 22.5% 116.7%Mean cost per consultation $131 $124 $121 $118 -4.9% -2.3%95% CI [117, 144] [114, 134] [112, 129] [112, 124]


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Table C48: Number and cost of internal medicine specialist services

Number and cost of internal medicine specialist services

(per quarter)



Num consultations 238 107 108 77 9 8 -55.1% -28.4% -10.1%Total cost $29,491 $13,593 $14,149 $10,238 $1,082 $962 -53.9% -27.6% -11.1%Mean cost per consultation

$124 $127 $131 $132 $122 $120 2.5% 1.0% -1.2%

95% CI [122, 126] [124, 130] [128, 134] [129, 136] [111, 132] [111, 130]

Table C49: Number and cost of internal medicine specialist services - Pre CVC contrasted against new to CVC

Number and cost of internal medicine specialist services

(per quarter)



IHT (pre CVC)

Num consultations 3 0 6 8 -89.8% 36.0%Total cost $398 $34 $684 $927 -91.4% 35.6%Mean cost per consultation $122 $103 $121 $121 -16.0% -0.3%95% CI [106, 139] [99, 106] [108, 135] [111, 131]


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Table C50: Number and cost of thoracic medicine specialist services

Number and cost of thoracic medicine specialist services

(per quarter)



Num consultations 635 573 358 486 18 30 -9.8% 35.7% 61.6%Total cost $72,452 $65,282 $41,429 $55,413 $2,214 $3,449 -9.9% 33.8% 55.8%Mean cost per consultation

$114 $114 $116 $114 $121 $117 -0.1% -1.4% -3.6%

95% CI [113, 115] [113, 115] [115, 117] [113, 115] [115, 128] [112, 121]

Table C51: Number and cost of thoracic medicine specialist services - Pre CVC contrasted against new to CVC

Number and cost of thoracic medicine specialist services

(per quarter)



IHT (pre CVC)

Num consultations 7 7 12 23 2.3% 94.4%Total cost $778 $804 $1,436 $2,645 3.3% 84.2%Mean cost per consultation $120 $121 $122 $116 1.0% -5.2%

95% CI [109, 130]

[109, 132]

[114, 130]

[111, 120]


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Table C52: Number and cost of vascular surgery specialist services

Number and cost of vascular surgery




Num consultations 205 155 99 92 4 4 -24.5% -7.2% 6.4%Total cost $13,781 $10,265 $6,877 $6,147 $245 $295 -25.5% -10.6% 20.3%Mean cost per consultation $67 $66 $69 $67 $65 $74 -1.4% -3.7% 13.1%95% CI [66, 68] [65, 67] [68, 71] [65, 68] [57, 73] [63, 85]

Table C53: Number and cost of vascular surgery specialist services - Pre CVC contrasted against new to CVC

Number and cost of vascular surgery specialist services

(per quarter)



IHT (pre CVC)

Num consultations 2 1 2 3 -24.0% 33.0%Total cost $116 $86 $129 $209 -25.9% 61.9%Mean cost per consultation $66 $65 $64 $78 -2.5% 21.7%95% CI [54, 78] [42, 87] [52, 76] [65, 91]


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Table C54: Number and cost of ophthalmology specialist services

Number and cost of ophthalmology




Num consultations 1,668 1,082 964 690 50 51 -35.2% -28.5% 2.2%Total cost $123,817 $79,554 $71,129 $50,053 $3,810 $3,622 -35.7% -29.6% -4.9%Mean cost per consultation

$74 $74 $74 $73 $76 $71 -0.9% -1.6% -7.0%

95% CI [74, 75] [73, 74] [73, 74] [72, 73] [74, 79] [69, 73]

Table C55: Number and cost of ophthalmology specialist services - Pre CVC contrasted against new to CVC

Number and cost of ophthalmology specialist services

(per quarter)



IHT (pre CVC)

Num consultations 10 14 40 37 39.5% -7.4%Total cost $904 $1,042 $2,906 $2,579 15.3% -11.2%Mean cost per consultation $88 $73 $73 $70 -17.4% -4.2%95% CI [82, 94] [68, 77] [70, 76] [68, 73]


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Table C56: Number and cost of geriatric specialist services

Number and cost of geriatric specialist




Num consultations 352 227 116 101 2 7 -35.5% -12.8% 343.4%Total cost $44,872 $28,652 $16,836 $15,046 $429 $976 -36.1% -10.6% 127.6%Mean cost per consultation

$127 $126 $145 $148 $286 $147 -1.0% 2.5% -48.7%

95% CI [124, 130] [123, 129] [137, 152] [141, 156] [145, 426] [111, 182]

Table C57: Number and cost of geriatric specialist services - Pre CVC contrasted against new to CVC

Number and cost of geriatric specialist services (per

quarter)



IHT (pre CVC)

Num consultations 0 0 2 7 - 343.4%Total cost $0 $0 $429 $976 - 127.6%Mean cost per consultation $0 $0 $286 $147 - -48.7%

95% CI [0, 0] [0, 0] [145, 426]

[111, 182]


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C.4 VETERANS’ HOME CARE SERVICESThe following section provides an analysis of the use of DVAs Veterans’ Home Care services by each cohort. Note: Those designated as group ‘IHT (new CVC)’ are those Telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as group ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial.

Veterans' Home Care (VHC) is designed to help veterans continue living at home by providing a small amount of practical help. VHC is not designed to meet complex or high-level care needs. DVA has contracted organisations to provide assessment and coordination of VHC services (known as VHC Assessment Agencies) and contracted organisations to deliver VHC services (known as VHC Service Providers) across Australia. Services include Domestic Assistance (e.g. support with basic household tasks such as cleaning, meal preparation support, bill paying), Personal Care (e.g. assistance with bathing, dressing, eating), Respite Care (e.g. in-home, residential, emergency short-term home relief), and safety-related Home and Garden Maintenance. It is noted that limited, short term Social Assistance may also be provided as part of the Coordinated Veterans’ Care (CVC) Program. Respite care emergency service data is not provided separately in this analysis due to limited service use and data, but has been included within the combined total for overall analysis. Note there were no Respite Care emergency services for the IHT cohort over baseline or trial periods.


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Table C58: Percentage change in number and cost of VHC services by type

Change in number and cost of VHC services by type (per quarter)


Personal care Num services 6.4% 25.6% 270.6% -20.0% 513.5%Proportion of all services -1.0% 2.6% 115.9% 106.4% 8.8%Total cost 21.4% 31.9% 387.8% 1.2% 694.8%Proportion of all costs 15.4% 9.0% 132.0% 51.5% 31.4%Mean cost per service 14.1% 5.0% 31.6% 26.5% 29.6%

Respite care – In-home

Num services 9.0% 18.4% -8.6% -70.0% 382.8%Proportion of all services 1.4% -3.3% -46.8% -22.6% -14.3%Total cost 1.1% 17.8% 83.1% -35.2% 461.1%

Proportion of all costs -3.9% -2.7% -12.9% -2.9% -7.2%Mean cost per service -7.3% -0.5% 100.4% 116.2% 16.2%

Total (personal care, respite care – in-home and emergency) *

Num services 7.6% 22.5% 71.7% -61.3% 463.7%Total cost 5.2% 21.0% 110.3% -33.2% 504.7%Mean cost per service -2.2% -1.2% 22.5% 72.3% 7.3%

* no respite care emergency services for IHT cohort


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Table C59: Change in number and cost of VHC services by type

Number and cost of VHC services by type (per quarter)

GCH CVC IHTBaseline Trial Baseline Trial Baseline Trial

Personal care Num services 1,404 1,495 623 782 17 62Proportion of all services

56.7% 56.1% 56.6% 58.0% 28.8% 62.1%

Total cost $33,229 $40,344 $15,602 $20,578 $333 $1,626Proportion of all costs 20.4% 23.5% 21.6% 23.5% 8.9% 20.7%Mean cost per service

$23.66 $26.99 $25.05 $26.30 $19.87 $26.15

95% CI [23.5, 23.9] [26.8, 27.2] [24.7, 25.4] [26.1, 26.5] [19.6, 20.2] [24.9, 27.4]Respite care – in-home

Num services 1,073 1,170 477 565 42 38Proportion of all services

43.3% 43.9% 43.3% 41.9% 71.2% 37.9%

Total cost $129,621 $131,073 $56,251 $66,236 $3,401 $6,226Proportion of all costs 79.5% 76.4% 77.8% 75.7% 91.1% 79.3%Mean cost per service

$120.83 $112.07 $117.86 $117.22 $81.84 $163.98

95% CI [118.8, 122.9] [110.3, 113.9] [115.7, 120.0] [114.6, 119.8] [76.7, 87.0] [157.0, 170.9]Total (personal care, respite care – in-home and emergency) *

Num services 2,477 2,665 1,101 1,348 58 100Cost 163,031 171,474 72,298 87,500 3,734 7,851Mean cost per service

66 64 66 65 64 78

95% CI [64.7, 66.9] [63.4, 65.3] [64.3, 67.0] [63.5, 66.3] [59.6, 68.5] [73.2, 83.6]* no respite care emergency services for IHT cohort


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Table C60: Change in number and cost of VHC services by type - Pre CVC contrasted against new to CVC

Number and cost of VHC services by typeIHT (new CVC) IHT (pre CVC)

Baseline Trial Baseline TrialPersonal care Num services 8 6 9 56

Proportion of all services 17.5% 36.2% 61.9% 67.3%Total cost $148 $149 $186 $1,477Proportion of all costs 5.4% 8.2% 18.6% 24.5%Mean cost per service $19.32 $24.44 $20.33 $26.3495% CI [18.7, 19.9] [20.3, 28.6] [20.3, 20.3] [25.0, 27.7]

Respite care – In-home Num services 36 11 6 27Proportion of all services 82.5% 63.8% 38.1% 32.7%Total cost $2,591 $1,679 $810 $4,547Proportion of all costs 94.6% 91.8% 81.4% 75.5%Mean cost per service $72.11 $155.88 $143.87 $167.1995% CI [67.1, 77.1] [152.6, 159.1] [137.0, 150.8] [157.6, 176.8]

Total (personal care, respite care – in-home) *

Num services 44 17 15 83Cost 2,738 1,828 996 6,024Mean cost per service 63 108 67 7295% CI [58.2, 67.5] [97.9, 118.8] [56.2, 78.7] [66.6, 78.1]

* no respite care emergency services for IHT cohort


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Table C61: Percentage change in cost of VHC services by VHC service type and region (per quarter)

Cohort VHC service type Bayside Darling Downs New England North Coast All regions

GCHPersonal Care 12.4% 134.4% 95.1% 64.5% 21.4%Respite Care - In Home 43.9% -11.6% -9.0% -4.4% 1.1%All 26.2% -9.7% -1.8% -2.7% 5.2%

CVCPersonal Care 7.7% - 96.3% 562.0% 31.9%Respite Care - In Home -20.6% 87.4% 74.5% 12.6% 17.8%All -4.8% 107.7% 84.0% 16.9% 21.0%

IHTPersonal Care 646.5% - - 62.1% 387.8%Respite Care - In Home - - -17.2% 197.0% 83.1%All 768.5% - -17.2% 184.8% 110.3%

IHT (new CVC)Personal Care - - - -18.3% 1.2%Respite Care - In Home - - -100.0% 21.2% -35.2%All - - -100.0% 17.4% -33.2%

IHT (pre CVC)Personal Care 631.1% - - - 694.8%Respite Care - In Home - - 123.4% 2614.8% 461.1%All 753.1% - 123.4% 2732.5% 504.7%

Note that ‘All’ services include: personal care, respite in home care, and respite care – emergency. Note also there were no respite care emergency services for the IHT cohort across baseline and trial periods.


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Table C62: Change in cost of VHC services by VHC service type and region (per quarter)

Cohort VHC Service Type

Region (costs per quarter)

Bayside Darling Downs New England North Coast All regions

Baseline Trial Baseline Trial Baseline Trial Baseline Trial Baseline Trial

GCH

Personal Care $29,455 $33,112 $463 $1,086 $2,286 $4,459 $1,025 $1,687 $33,229 $40,344Respite Care - Emergency $0 $0 $0 $0 $182 $0 $0 $57 $182 $57Respite Care - In Home $22,870 $32,902 $35,721 $31,584 $28,500 $25,945 $42,530 $40,642 $129,621 $131,073All $52,324 $66,014 $36,184 $32,670 $30,967 $30,405 $43,556 $42,386 $163,031 $171,474

CVC

Personal Care $14,299 $15,400 $0 $1,302 $1,019 $2,001 $283 $1,875 $15,602 $20,578Respite Care - Emergency $0 $0 $0 $0 $0 $159 $446 $527 $446 $686Respite Care - In Home $11,223 $8,906 $6,405 $11,999 $2,977 $5,193 $35,647 $40,137 $56,251 $66,236All $25,521 $24,306 $6,405 $13,301 $3,996 $7,353 $36,376 $42,540 $72,298 $87,500

IHT

Personal Care $186 $1,387 $0 $0 $0 $0 $148 $239 $333 $1,626Respite Care - Emergency $0 $0 $0 $0 $0 $0 $0 $0 $0 $0Respite Care - In Home $0 $227 $0 $0 $1,915 $1,585 $1,486 $4,413 $3,401 $6,226All $186 $1,613 $0 $0 $1,915 $1,585 $1,634 $4,653 $3,734 $7,851

IHT (new CVC)

Personal Care $0 $29 $0 $0 $0 $0 $148 $121 $148 $149Respite Care - Emergency $0 $0 $0 $0 $0 $0 $0 $0 $0 $0Respite Care - In Home $0 $0 $0 $0 $1,205 $0 $1,385 $1,679 $2,591 $1,679All $0 $29 $0 $0 $1,205 $0 $1,533 $1,799 $2,738 $1,828

IHT (pre CVC)

Personal Care $186 $1,358 $0 $0 $0 $0 $0 $119 $186 $1,477Respite Care - Emergency $0 $0 $0 $0 $0 $0 $0 $0 $0 $0Respite Care - In Home $0 $227 $0 $0 $710 $1,585 $101 $2,735 $810 $4,547All $976 $5,981 $0 $0 $5,669 $13,194 $805 $22,658 $7,450 $41,833

Note that ‘All’ services include: personal care, respite in home care, respite care-emergency. Note also there were no respite care emergency services for the IHT cohort across baseline and trial periods.


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C.5 COMMUNITY NURSING SERVICESThe following section provides an analysis of the use of DVAs community nursing services by each cohort. Note: Those designated as group ‘IHT (new CVC)’ are those Telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as group ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial.

The DVA Community Nursing Program provides home community nursing services for entitled persons to meet their assessed clinical and personal care needs. The aim of DVA’s Community Nursing Program is to enhance the independence and health outcomes of the entitled person by avoiding early admission to hospital and/or residential care through access to community nursing services. These community nursing services are delivered by registered nurses, enrolled nurses and nursing support staff. Services may include clinical care (e.g. medication administration), personal care (e.g. assistance with medication), clinical overnight nursing for palliative care (e.g. as part of exceptional case status), CVC Program, and provision of wound management consumables. Entitled persons must hold a Gold Card or a White Card. White Card holders may be eligible for non-liability health care treatment, whether war caused or not, for a range of specified condition.


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Table C63: Change in community nursing service use and costs

Community nursing services and costs

GCH CVC IHT % Change for each cohort(n = 1630) (n = 1527) (n = 957) (n = 1110) (n = 36) (n = 50)


Clients (total) 1,630 1,527 957 1,110 36 50 -6.3% 16.0% 38.9%Episodes (per qtr) 449 333 254 234 9 11 -26.0% -8.0% 25.2%Services (per qtr) 3,392 4,212 2,018 3,196 62 171 24.2% 58.3% 177.4%Visits (per qtr) 1,513 1,612 874 1,186 24 54 6.6% 35.7% 127.4%Total hours (per qtr) 29,608 26,109 16,207 19,273 413 913 -11.8% 18.9% 121.0%Total cost (per qtr) $2,236,157 $2,397,929 $1,296,260 $1,770,398 $29,064 $80,894 7.2% 36.6% 178.3%

Average Hours % Change for each cohortPer client (per qtr) 18 17 17 17 11 18 -5.9% 2.5% 59.1%Per episode 66 79 64 82 49 86 19.1% 29.3% 76.5%

Average Cost % Change for each cohortPer client (per qtr) $1,372 $1,570 $1,355 $1,595 $807 $1,618 14.5% 17.8% 100.4%Per episode $4,978 $7,210 $5,101 $7,576 $3,415 $7,591 44.8% 48.5% 122.3%Per service $659 $569 $642 $554 $472 $473 -13.6% -13.7% 0.3%Per consultation $1,478 $1,487 $1,484 $1,493 $1,235 $1,512 0.6% 0.6% 22.4%

Average Episodes, Services and Visits % Change for each cohortEpisodes per client (per qtr)

0.3 0.2 0.3 0.2 0.2 0.2 -21.0% -20.7% -9.9%

Services per client (per qtr)

2.1 2.8 2.1 2.9 1.7 3.4 32.6% 36.5% 99.7%

Services per episode 7.6 12.7 7.9 13.7 7.2 16.0 67.7% 72.2% 121.6%Visits per episode 3.4 4.8 3.4 5.1 2.8 5.0 43.9% 47.6% 81.6%Visits per client (per qtr) 0.9 1.1 0.9 1.1 0.7 1.1 13.8% 17.0% 63.7%


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Table C64: Change in community nursing service use and costs- Pre CVC contrasted against new to CVC

Community nursing services and costs


(n = 9) (n = 14) (n = 27) (n = 36)IHT (new CVC) IHT (pre CVC)Baseline Trial Baselin

eTrial

Clients (total) 9 14 27 36 55.6% 33.3%Episodes (per qtr) 2 3 7 7 111.5% 4.8%

Services (per qtr) 16 46 46 125 194.0% 171.8%Visits (per qtr) 5 14 19 40 182.0% 113.1%Total hours (per qtr) 127 222 286 691 75.3% 141.2%Total cost (per qtr) $8,924 $23,824 $20,139 $57,071 167.0% 183.4%

Average Hours % Change for each cohort

Per client (per qtr) 14 16 11 19 12.7% 80.9%Per episode 78 65 42 96 -17.1% 130.2%

Average Cost % Change for each cohort

Per client (per qtr) $992 $1,702 $746 $1,585 71.6% 112.5%Per episode $5,484 $6,923 $2,925 $7,909 26.2% 170.4%Per service $575 $522 $437 $456 -9.2% 4.2%Per visit $1,828 $1,731 $1,080 $1,436 -5.3% 33.0%

Average Episodes, Services and Visits % Change for each cohort

Episodes per client (per qtr)

0.2 0.2 0.3 0.2 36.0% -21.4%

Services per client (per qtr)

1.7 3.3 1.7 3.5 89.0% 103.9%

Services per episode 9.5 13.3 6.7 17.4 39.0% 159.4%Visits per episode 3.0 4.0 2.7 5.5 33.3% 103.3%Visits per client (per qtr) 0.5 1.0 0.7 1.1 81.3% 59.8%


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Table C65: Percentage change in community nursing service use and costs by region

Use and cost of community nursing services by region


Bayside Clients (total) -6.7% 34.5% 600.0% - 600.0%Episodes (per qtr) 43.1% 92.1% 989.6% - 989.6%Total cost (per qtr) 27.0% 71.1% 399.9% - 399.9%Cost per client (per qtr) 36.1% 27.2% -28.6% - -28.6%Episodes per client (per qtr)

53.4% 42.8% 55.7% - 55.7%

Darling Downs

Clients (total) -3.7% 16.7% 100.0% 50.0% 150.0%Episodes (per qtr) 83.3% 89.7% 171.5% 83.3% 259.7%Total cost (per qtr) 36.2% 32.0% 353.4% 101.3% 919.8%Cost per client (per qtr) 41.4% 14.0% 126.7% 34.2% 307.9%Episodes per client (per qtr)

90.4% 63.9% 35.7% 22.2% 43.9%

New England Clients (total) -11.3% 9.4% 0.0% - -40.0%Episodes (per qtr) 54.4% 45.3% 140.7% - 102.7%Total cost (per qtr) 26.8% 41.4% 24.0% - 22.6%Cost per client (per qtr) 43.0% 29.3% 24.0% - 104.3%Episodes per client (per qtr)

74.1% 32.9% 140.7% - 237.9%

North Coast Clients (total) -5.2% 11.7% 15.4% 28.6% 10.5%Episodes (per qtr) 5.9% 2.6% -12.7% 98.7% -40.0%Total cost (per qtr) 25.7% 58.9% 195.6% 204.5% 190.8%Cost per client (per qtr) 32.6% 42.3% 156.2% 136.9% 163.1%Episodes per client (per qtr)

11.7% -8.1% -24.4% 54.5% -45.7%


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Note: No IHT (new CVC) clients for Bayside or New England in 2012-14. (Baseline period); Episode and client numbers are small for IHT (new CVC) and IHT (pre CVC) – interpret with caution

Table C66: Change in community nursing service use and costs by region

Community nursing service use and cost by region

GCH CVC IHT

(n = 1630) (n = 1527) (n = 957) (n = 1110) (n = 36) (n = 50)


Bayside Clients (total) 372 347 165 222 1 7Proportion 23% 23% 17% 20% 3% 14%Episodes (per qtr) 79 113 36 70 0 1Proportion 17% 19% 14% 21% 1% 12%Total cost (per qtr) $322,021 $408,869 $178,007 $304,566 $969 $4,843Proportion 14% 14% 14% 15% 3% 6%Cost per client (per qtr) $866 $1,178 $1,079 $1,372 $969 $69295% CI [733, 998] [1002, 1355] [820, 1338] [1102, 1642] [969, 969] [-215, 1598]Episode per client (per qtr)

0.2 0.3 0.2 0.3 0.1 0.2

95% CI [0.2, 0.2] [0.3, 0.4] [0.2, 0.2] [0.3, 0.4] [0.1, 0.1] [0.1, 0.3]Darling Downs Clients (total) 216 208 114 133 4 8

Proportion 13% 14% 12% 12% 11% 16%Episodes (per qtr) 51 93 26 49 1 1Proportion 11% 16% 10% 15% 6% 12%Total cost (per qtr) $215,965 $294,036 $95,810 $126,487 $2,487 $11,276Proportion 10% 10% 7% 6% 9% 14%Cost per client (per qtr) $1,000 $1,414 $840 $958 $622 $1,41095% CI [815, 1185] [1112, 1715] [586, 1095] [740, 1177] [-140, 1384] [663, 2156]Episode per client (per qtr)

0.2 0.4 0.2 0.4 0.1 0.2


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Community nursing service use and cost by region

GCH CVC IHT

(n = 1630) (n = 1527) (n = 957) (n = 1110) (n = 36) (n = 50)


95% CI [0.2, 0.3] [0.2, 0.7] [0.2, 0.3] [0.1, 0.6] [0.1, 0.1] [0.1, 0.2]New England Clients (total) 256 227 96 105 5 5

Proportion 16% 15% 10% 9% 14% 10%Episodes (per qtr) 58 90 25 36 1 2Proportion 13% 15% 9% 11% 10% 19%Total cost (per qtr) $479,751 $608,476 $131,580 $186,026 $4,976 $6,167Proportion 21% 21% 10% 9% 17% 7%Cost per client (per qtr) $1,874 $2,681 $1,371 $1,772 $995 $1,23395% CI [1600, 2148] [2320, 3041] [999, 1742] [1346, 2197] [-508, 2498] [-370, 2837]Episode per client (per qtr)

0.2 0.4 0.3 0.3 0.2 0.4

95% CI [0.2, 0.3] [0.3, 0.5] [0.2, 0.3] [0.3, 0.4] [0.0, 0.3] [-0.2, 1.1]North Coast Clients (total) 786 745 582 650 26 30

Proportion 48% 49% 61% 59% 72% 60%Episodes (per qtr) 271 287 177 182 7 6Proportion 59% 49% 67% 54% 82% 56%Total cost (per qtr) $1,219,508 $1,532,604 $891,007 $1,416,246 $20,632 $60,986Proportion 55% 54% 69% 70% 71% 73%Cost per client (per qtr) $1,552 $2,057 $1,531 $2,179 $794 $2,03395% CI [1433, 1670] [1902, 2212] [1376, 1686] [1996, 2361] [257, 1331] [1352, 2714]Episode per client (per qtr)

0.3 0.4 0.3 0.3 0.3 0.2

95% CI [0.3, 0.4] [0.3, 0.5] [0.3, 0.3] [0.2, 0.3] [0.1, 0.5] [0.2, 0.3]


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C.6 TRANSPORT SERVICESThe following section provides an analysis of the use of DVAs transport services by each cohort. Note: Those designated as group ‘IHT (new CVC)’ are those Telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as group ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial.

DVA provides eligible persons (and their medically required attendants) assistance with their transport when travelling for approved medical treatment and to approved treatment locations. DVA accepts financial responsibility for ambulance transport in a medical emergency for Gold Card or White Card holders in relation to an accepted disability. DVA will pay for non-emergency ambulance transport only in certain circumstances.

Table C67: Change in use and cost of Transport service by cohort

Use and cost of Transport service by cohort (per quarter)

GCH CVC IHT % Change for each cohort(n = 4009) (n = 4280) (n = 2022) (n = 2193) (n = 133) (n = 144)


Number of services 9,525 11,588 6,712 7,747 506 654 21.7% 15.4% 29.3%Total cost $1,203,793 $2,293,317 $634,774 $1,069,959 $44,490 $63,720 90.5% 68.6% 43.2%Average services per client

2.4 2.7 3.3 3.5 3.8 4.5 14.0% 6.4% 19.4%

95% CI [2.2, 2.5] [2.5, 2.9] [3.0, 3.6] [3.3, 3.8] [2.9, 4.7] [3.5, 5.5]Average cost per client $300 $536 $314 $488 $335 $442 78.6% 55.4% 32.3%95% CI [285, 316] [496, 576] [288, 339] [457, 518] [241, 429] [350, 535]


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Table C68: Change in use and cost of Transport service by cohort - Pre CVC contrasted against new to CVC

Use and cost of Transport service by

cohort

IHT (new CVC) IHT (pre CVC) % Change for each cohort(n = 45) (n = 50) (n = 88) (n = 94)

IHT (new CVC) IHT (pre CVC)Baseline Trial Baseline Trial

Number of services 144 195 362 459 34.9% 27.0%Total cost $17,099 $21,609 $27,391 $42,111 26.4% 53.7%Average services per client

3.2 3.9 4.1 4.9 21.4% 18.9%

95% CI [1.8, 4.6] [2.6, 5.2] [2.9, 5.3] [3.5, 6.3]Average cost per client $380 $432 $311 $448 13.7% 43.9%95% CI [165, 595] [261, 603] [218, 405] [336, 560]

Table C69: Change in transport use and cost by region

Transport use and cost by

region

Num IHT Clients (total) Transport Total costs per quarter

(proportion of all)

Mean cost per client per quarter(95% CI)

% Change baseline to trial

Baseline Trial Baseline Trial Baseline Trial # clients Total cost Av CostBayside 21 26 $1,814 $6,818 $86 $262 123.8% 375.8% 303.5%

4% 11% [43, 130] [146, 378]Darling Downs 25 28 $13,943 $16,867 $558 $602 112.0% 121.0% 108.0%

31% 26% [340, 775] [382, 823]New England 10 14 $2,254 $4,141 $225 $296 140.0% 183.7% 131.2%

5% 6% [77, 374] [124, 468]North Coast 77 76 $26,479 $35,893 $344 $472 98.7% 135.6% 137.3%

60% 56% [202, 486] [324, 621]All 133 144 $44,490 $63,720 $335 $442 108.3% 143.2% 132.3%

100% 100% [241, 429] [350, 535]


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Table C70: Change in ambulance use and cost

Use and cost of ambulance (per

quarter)

GCH CVC IHT % Change for each cohortBaseline Trial Baseline Trial Baseline Trial GCH CVC IHT

Num services 782 2,008 323 800 11 25 156.6% 147.3% 134.3%Total cost $504,388 $1,572,729 $208,832 $635,831 $7,416 $21,633 211.8% 204.5% 191.7%Mean Services per client

0.3 0.7 0.3 0.5 0.2 0.3 96.2% 76.8% 52.6%

95% CI [0.3, 0.4] [0.6, 0.7] [0.3, 0.3] [0.5, 0.5] [0.2, 0.2] [0.2, 0.3]Mean cost per client $219 $521 $187 $407 $132 $252 138.5% 117.6% 89.9%95% CI [204, 233] [468, 574] [175, 199] [379, 434] [108, 157] [211, 292]

Table C71: Change in Ambulance use and cost - Pre CVC contrasted against new to CVC

Use and cost of travel types (per quarter)

IHT (new CVC) IHT (pre CVC) % Change for each cohortBaseline Trial Baseline Trial IHT (new CVC) IHT (pre CVC)

Num services 3 7 7 18 112.3% 144.6%Total cost $2,380 $6,216 $5,035 $15,417 161.1% 206.2%Mean services per client 0.2 0.2 0.2 0.3 24.4% 67.3%95% CI [0.2, 0.2] [0.2, 0.3] [0.1, 0.2] [0.3, 0.4]Mean cost per client $140 $214 $129 $270 53.1% 109.5%95% CI [103, 177] [138, 291] [97, 161] [222, 319]


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Table C72: Change in use of booked Car with a Driver

Use and cost of travel types (per

quarter)


Num services 5,355 6,263 4,480 5,151 218 333 17.0% 15.0% 52.7%Total cost $468,480 $488,297 $322,144 $323,733 $23,031 $29,082 4.2% 0.5% 26.3%Mean services per client

2.3 2.7 3.1 3.4 2.4 3.3 17.3% 11.3% 39.0%

95% CI [2.1, 2.5] [2.4, 2.9] [2.8, 3.4] [3.1, 3.7] [1.6, 3.2] [2.5, 4.2]Mean cost per client $198 $207 $221 $215 $253 $291 4.5% -2.7% 14.9%95% CI [180, 216] [188, 226] [191, 251] [187, 243] [148, 359] [195, 387]

Table C73: Change in use of booked car with a driver - Pre CVC contrasted against new to CVC


quarter)

IHT (new CVC) IHT (pre CVC) % Change for each cohortBaseline Trial Baseline Trial IHT (new

CVC)IHT (pre CVC)

Num services 55 91 163 242 64.5% 48.7%Total cost $9,689 $10,558 $13,342 $18,524 9.0% 38.8%Mean services per client

2.4 3.3 2.4 3.4 35.1% 40.4%

95% CI [1.0, 3.8] [1.8, 4.7] [1.5, 3.3] [2.3, 4.4]Mean cost per client $421 $377 $196 $257 -10.5% 31.1%95% CI [49, 793] [125, 629] [124, 268] [163, 352]


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Table C74: Change in Food, Accommodation & Other Reimbursement


quarter)


Num services 3,388 3,316 1,909 1,796 277 296 -2.1% -5.9% 6.8%Total cost $230,926 $232,291 $103,797 $110,396 $14,044 $13,005 0.6% 6.4% -7.4%Mean Services per client

2.9 3.5 3.5 3.8 4.3 4.8 22.7% 8.8% 11.9%

95% CI [2.6, 3.2] [3.1, 3.9] [3.0, 4.0] [3.2, 4.4] [2.9, 5.6] [3.2, 6.4]Mean cost per client $196 $247 $190 $234 $216 $210 26.1% 23.0% -2.9%95% CI [174, 217] [216, 277] [152, 228] [185, 283] [117, 315] [115, 305]

Table C75: Change in Food, Accommodation & Other Reimbursement- Pre CVC contrasted against new to CVC

Use and cost of travel types (per quarter)


Num services 85 96 192 200 12.6% 4.2%Total cost $5,029 $4,835 $9,014 $8,169 -3.9% -9.4%Mean Services per client 3.9 4.2 4.5 5.1 7.7% 14.8%95% CI [1.7, 6.0] [2.2, 6.2] [2.7, 6.2] [2.8, 7.5]Mean cost per client $229 $210 $210 $209 -8.0% -0.1%95% CI [102, 355] [108, 312] [72, 348] [67, 352]


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C.7 ALLIED HEALTH SERVICESThe following section provides an analysis of the use of allied health services by each cohort. It includes visits to all services, and targeted allied health service providers related to the target chronic conditions of the trial. Note: Those designated as ‘IHT (new CVC)’ are those telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as ‘IHT (pre CVC)’ are those telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial. For the purposes of this analysis, targeted allied health services include: physiotherapy, podiatry, occupational therapy, dietetics, diabetes education, and optical services. This approach aimed to support evaluation of the trial’s impacts on changes in management of the four targeted chronic conditions.

Table C76: Change in use and cost of total allied health services

Number and cost of targeted allied

health services (per quarter)

GCH CVC IHT % Change for each cohort(n = 5317) (n = 4969) (n = 2532) (n = 2498) (n = 161) (n = 163)Baseline Trial Baseline Trial Baseline Trial GCH CVC IHT

Num services 150,109 134,401 80,949 80,215 5,526 6,219 -10.5% -0.9% 12.6%Total cost $9,171,034 $8,287,428 $5,537,621 $5,660,518 $404,413 $504,542 -9.6% 2.2% 24.8%Mean cost per service $61 $62 $68 $71 $73 $81 0.9% 3.2% 10.8%95% CI [60.9, 61.3] [61.5, 61.9] [68.1, 68.7] [70.2, 70.9] [71.9, 74.5] [80.0, 82.3]

Mean cost per client $1,584 $1,960 $2,120 $2,591 $2,422 $3,051 23.7% 22.2% 26.0%95% CI [1553,

1615][1856, 2063]

[2071, 2170]

[2510, 2671]

[2232, 2611]

[2843, 3258]


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Table C77: Change in use and cost of total allied health services- Pre CVC contrasted against new to CVC

Number and cost of targeted allied

health services (per quarter)

IHT (new CVC) IHT (pre CVC) % Change for each cohort(n = 59) (n = 59) (n = 102) (n = 104)Baseline Trial Baseline Trial IHT (new CVC) IHT (pre CVC)

Num services 1,813 1,844 3,713 4,376 1.7% 17.9%Total cost $126,872 $156,655 $277,541 $347,887 23.5% 25.3%Mean cost per service $70 $85 $75 $80 21.4% 6.4%95% CI [67.6, 72.3] [82.7, 87.2] [73.2, 76.3] [78.2, 80.8]

Mean cost per client $2,150 $2,683 $2,570 $3,251 24.8% 26.5%95% CI [1809, 2492] [2380, 2987] [2345, 2795] [2981, 3522]

Table C78: Change in use and cost of all targeted allied health services

Number and cost of targeted allied health services (per quarter)

GCH CVC IHT % Change for each cohort(n =

5317)(n =

4969)(n =

2532)(n =

2498) (n = 161) (n = 163)

Baseline Trial Baseline Trial Baseline Trial GCH CVC IHTNum services 22,667 19,110 12,539 12,093 893 978 -15.7% -3.6% 9.5%Total cost $1,519,183 $1,310,552 $836,861 $830,434 $59,946 $67,871 -13.7% -0.8% 13.2%Mean cost per service $67.0 $68.6 $66.7 $68.7 $67.1 $69.4 2.3% 2.9% 3.4%95% CI [66.8,

67.2][68.4, 68.8]

[66.5, 67.0]

[68.4, 68.9]

[66.1, 68.1]

[68.5, 70.3]

Mean cost per client $286 $312 $330 $374 $374 $423 9.3% 13.1% 13.3%95% CI [276, 296] [300, 324] [316, 345] [357, 390] [302, 445] [363, 484]


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Table C79: Change in use and cost of all targeted allied health services- Pre CVC contrasted against new to CVC

Number and cost of targeted allied health services (per quarter)

IHT (new CVC) IHT (pre CVC) % Change for each cohort(n = 59) (n = 59) (n = 102) (n = 104)Baseline Trial Baseline Trial IHT (new CVC) IHT (pre CVC)

Num services 257 292 636 686 13.6% 7.9%Total cost 100% 100% 100% 100% 14.0% 12.9%Mean cost per service $17,586 $20,049 $42,360 $47,822 0.4% 4.7%95% CI 100% 100% 100% 100%Mean cost per client $68.4 $68.6 $66.6 $69.7 16.0% 13.8%95% CI [66.4, 70.4] [67.2, 70.1] [65.4, 67.8] [68.5, 70.8]

Table C80: Change in use and cost of physiotherapy services

Number and cost of physiotherapy




Num services 12,367 10,563 6,357 6,402 502 533 -14.6% 0.7% 6.3%% of select AH services

55% 55% 51% 53% 56% 55% 1.3% 4.4% -2.9%

Total cost $771,064 $668,896 $387,665 $399,242 $30,623 $33,241 -13.3% 3.0% 8.5%% of select AH services

51% 51% 46% 48% 51% 49% 0.6% 3.8% -4.1%

Mean cost per service

$62.3 $63.3 $61.0 $62.4 $61.0 $62.3 1.6% 2.3% 2.1%

95% CI [62.3, 62.4] [63.2, 63.4] [60.9, 61.1] [62.2, 62.5] [60.7, 61.3] [62.0, 62.7]Mean cost per client

$294 $323 $273 $310 $333 $303 9.6% 13.4% -9.0%

95% CI [278, 310] [304, 341] [253, 293] [287, 332] [229, 436] [228, 378]


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Table C81: Change in use and cost of Physiotherapy Services- Pre CVC contrasted against new to CVC

Number and cost of physiotherapy services (per

quarter)



IHT (pre CVC)

Num services 149 158 352 375 5.9% 6.5%% of select AH services 58% 54% 55% 55% -6.8% -1.3%Total cost $9,290 $9,770 $21,333 $23,470 5.2% 10.0%% of select AH services 53% 49% 50% 49% -7.7% -2.5%Mean cost per service $62.2 $61.7 $60.5 $62.6 -0.7% 3.3%95% CI [61.6, 62.7] [61.2, 62.2] [60.2, 60.9] [62.1, 63.0]Mean cost per client $319 $252 $332 $334 -21.1% 0.7%95% CI [141, 498] [114, 390] [200, 463] [243, 425]

Table C82: Change in use and cost of podiatry services

Number and cost of podiatry



Num services 6,390 5,228 3,801 3,483 257 284 -18.2% -8.4% 10.3%% of select AH services

28% 27% 30% 29% 29% 29% -3.0% -5.0% 0.7%

Total cost $428,581 $357,150 $252,260 $238,895 $18,058 $20,326 -16.7% -5.3% 12.6%% of select AH services

28% 27% 30% 29% 30% 30% -3.4% -4.6% -0.6%


$67.1 $68.3 $66.4 $68.6 $70.1 $71.6 1.9% 3.4% 2.0%

95% CI [66.6, 67.5]

[67.8, 68.8]

[65.7, 67.0]

[68.0, 69.2]

[67.2, 73.1] [69.0, 74.1]


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services (per


Mean cost per client $114 $114 $124 $127 $136 $151 0.6% 2.3% 10.7%95% CI [111, 116] [111, 117] [121, 128] [123, 131] [120, 152] [135, 167]

Table C83: Change in use and cost of podiatry services- Pre CVC contrasted against new to CVC




Num services 63 78 195 206 24.2% 5.9%% of select AH services

24% 27% 31% 30% 9.3% -1.9%

Total cost $4,452 $5,240 $13,606 $15,086 17.7% 10.9%% of select AH services

25% 26% 32% 32% 3.2% -1.8%


$70.9 $67.1 $69.9 $73.2 -5.2% 4.8%

95% CI [64.3, 77.5]

[63.3, 70.9]

[66.6, 73.2] [70.0, 76.5]

Mean cost per client

$112 $121 $147 $166 7.9% 13.1%

95% CI [87, 138] [97, 145] [126, 167] [145, 187]


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Table C84: Change in use and cost of occupational therapy services

No and cost of occupational therapy services (per quarter)


Num services 1,830 1,600 1,232 1,190 59 89 -12.6% -3.4% 50.1%% of select AH services 8% 8% 10% 10% 7% 9% 3.7% 0.1% 37.0%Total cost $159,362 $145,078 $106,659 $108,778 $5,209 $8,240 -9.0% 2.0% 58.2%% of select AH services 10% 11% 13% 13% 9% 12% 5.5% 2.8% 39.7%Mean cost per service $87.1 $90.7 $86.6 $91.4 $87.8 $92.6 4.1% 5.6% 5.4%95% CI [86.6, 87.6] [90.2, 91.1] [86.0, 87.1] [90.9, 91.9] [85.3, 90.3] [90.8, 94.3]Mean cost per client $71 $84 $73 $82 $60 $84 18.4% 12.9% 39.5%95% CI [68, 74] [79, 89] [69, 77] [78, 86] [47, 74] [68, 100]

Table C85: Change in use and cost of occupational therapy Services- Pre CVC contrasted against new to CVC

No and cost of occupational therapy services (per

quarter)


Num services 18 29 41 60 58.1% 46.5%% of select AH services 7% 10% 6% 9% 39.1% 35.8%Total cost $1,676 $2,769 $3,533 $5,471 65.2% 54.9%% of select AH services 10% 14% 8% 11% 44.9% 37.2%Mean cost per service $91.1 $95.2 $86.3 $91.3 4.5% 5.7%95% CI [86.1,

96.1][91.7, 98.7]

[83.4, 89.2]

[89.4, 93.1]

Mean cost per client $69 $100 $56 $79 43.6% 41.9%95% CI [33, 106] [57, 142] [42, 69] [63, 94]


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Table C86: Change in use and cost of dietetic services

No and cost of dietetic services (per

quarter)


Num services 315 270 292 264 16 12 -14.2% -9.5% -22.6%% of select AH services 1% 1% 2% 2% 2% 1% 1.8% -6.2% -29.3%Total cost $25,358 $22,050 $23,038 $21,787 $1,261 $1,007 -13.0% -5.4% -20.1%% of select AH services 2% 2% 3% 3% 2% 1% 0.8% -4.7% -29.4%Mean cost per service $80.5 $81.6 $78.9 $82.4 $80.0 $82.5 1.3% 4.5% 3.2%95% CI [79.9, 81.1] [81.0, 82.2] [78.3, 79.4] [81.8, 82.9] [77.3, 82.6] [79.2, 85.8]Mean cost per client $53 $76 $66 $70 $45 $32 42.0% 7.1% -27.9%95% CI [47, 60] [42, 109] [58, 73] [59, 81] [31, 58] [19, 46]

Table C87: Change in use and cost of dietetic services- Pre CVC contrasted against new to CVC

No and cost of dietetic services (per quarter)


Num services 4 3 12 9 -20.8% -23.1%% of select AH services 1% 1% 2% 1% -30.3% -28.7%Total cost $275 $227 $986 $781 -17.5% -20.8%% of select AH services 2% 1% 2% 2% -27.6% -29.9%Mean cost per service $78.4 $81.6 $80.4 $82.8 4.2% 2.9%95% CI [72.9,

83.8][72.8, 90.5]

[77.4, 83.5]

[79.2, 86.3]

Mean cost per client $26 $22 $59 $39 -15.6% -34.3%95% CI [15, 37] [10, 34] [39, 78] [18, 59]

Table C88: Change in use and cost of diabetes educator services

Number and cost of GCH CVC IHT % Change for each cohort


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diabetes educator services (per

quarter)


Num services 17 14 17 16 3 1 -15.2% -5.4% -42.4%% of select AH services

0% 0% 0% 0% 0% 0% 0.6% -1.9% -47.4%

Total cost $1,196 $1,080 $1,203 $1,131 $187 $112 -9.7% -6.0% -40.1%% of select AH services

0% 0% 0% 0% 0% 0% 4.7% -5.3% -47.1%

Mean cost per service $70.2 $74.8 $71.2 $70.8 $74.6 $77.5 6.6% -0.6% 3.9%95% CI [68.2,

72.3][72.4, 77.3]

[68.8, 73.6]

[68.6, 72.9]

[69.2, 80.0]

[70.4, 84.5]

Mean cost per client $26 $25 $22 $28 $21 $18 -4.3% 26.2% -14.2%95% CI [20, 32] [19, 31] [16, 29] [16, 40] [15, 27] [7, 29]


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Table C89: Change in use and cost of Diabetic Educator Services- Pre CVC contrasted against new to CVC

Number and cost of diabetes educator services (per

quarter)


Num services 2 1 1 0 -39.0% -55.7%% of select AH services 1% 0% 0% 0% -46.3% -58.9%Total cost $155 $98 $31 $14 -37.1% -55.1%% of select AH services 1% 0% 0% 0% -44.8% -60.2%Mean cost per service $77.6 $80.1 $62.5 $63.3 3.1% 1.3%95% CI [71.8,

83.5][72.8, 87.3]

[60.8, 64.2]

[63.3, 63.3]

Mean cost per client $19 $19 $0 $0 -2.5% -95% CI [14, 25] [4, 33] [0, 0] [0, 0]

Table C90: Change in use and cost of optical services

Number and cost of optical services (per

quarter)


Num services 1,748 1,434 839 738 56 58 -18.0% -12.1% 3.0%% of select AH services 8% 8% 7% 6% 6% 6% -2.7% -8.8% -5.9%Total cost $133,622 $116,300 $66,035 $60,600 $4,609 $4,945 -13.0% -8.2% 7.3%% of select AH services 9% 9% 8% 7% 8% 7% 0.9% -7.5% -5.2%Mean cost per service $76.4 $81.1 $78.7 $82.1 $81.6 $85.0 6.1% 4.3% 4.1%95% CI [75.2, 77.7] [79.7, 82.5] [76.8, 80.5] [80.2, 84.0] [74.3, 89.0] [77.8, 92.2]Mean cost per client $39 $43 $39 $41 $37 $40 10.9% 6.6% 6.4%95% CI [38, 39] [41, 45] [38, 40] [40, 43] [34, 40] [36, 44]

Table C91: Change in use and cost of optical services- Pre CVC contrasted against new to CVC

Number and cost of optical IHT (new CVC) IHT (pre CVC) % Change for each cohortAppendices to Final reportAugust 2017

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services (per quarter)Baseline Trial Baseline Trial IHT (new CVC) IHT (pre CVC)

Num services 21 23 36 36 8.3% -0.1%% of select AH services 8% 8% 6% 5% -4.6% -7.4%Total cost $1,738 $1,946 $2,871 $2,999 12.0% 4.5%% of select AH services 10% 10% 7% 6% -1.8% -7.5%Mean cost per service $83.2 $85.9 $80.8 $84.4 3.3% 4.6%95% CI [70.9,

95.4][74.1, 97.7]

[71.4, 90.1]

[75.2, 93.6]

Mean cost per client $37 $39 $37 $40 6.1% 7.8%95% CI [32, 42] [33, 45] [34, 41] [35, 45]

Table C92: Percentage change in mean cost per client per quarter for targeted allied health services by region

Percentage Change in targeted allied health service costs by region

(per quarter)

% Change for each cohortGCH CVC IHT IHT (new CVC) IHT (pre CVC)

Bayside 10.1% 17.0% 15.6% 24.5% 14.0%Darling Downs 15.6% 20.6% 27.2% 6.3% 50.6%New England 5.7% -2.4% 18.4% 132.5% -2.5%North Coast 7.3% 10.8% 10.9% 14.0% 12.8%Total 9.3% 13.1% 13.3% 16.0% 13.8%


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Table C93: Change in mean cost per client per quarter of targeted allied health services by region

Change in targeted allied health service costs by region

(per quarter)


BaysideMean cost per client

$368 $405 $398 $466 $376 $435

95% CI [346, 390] [380, 430] [367, 430] [430, 503] [235, 517] [280, 589]

Darling Downs

Mean cost per client

$214 $247 $239 $288 $281 $357

95% CI [198, 230] [225, 270] [216, 262] [257, 319] [200, 362] [255, 460]

New EnglandMean cost per client

$201 $213 $209 $204 $142 $168

95% CI [184, 219] [194, 232] [181, 236] [174, 233] [53, 230] [68, 267]

North CoastMean cost per client

$276 $296 $352 $390 $439 $487

95% CI [262, 291] [277, 315] [329, 374] [365, 414] [320, 558] [396, 578]

TotalMean cost per client

$286 $312 $330 $374 $374 $423

95% CI [276, 296] [300, 324] [316, 345] [357, 390] [302, 445] [363, 484]


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Table C94: Change in mean cost per client of targeted allied health services by region- Pre CVC contrasted against new to CVC

Change in targeted allied health service costs by region


BaysideMean cost per client $403 $501 $343 $39295% CI [23, 782] [84, 919] [248, 439] [272, 511]

Darling DownsMean cost per client $288 $306 $261 $39395% CI [88, 488] [122, 490] [216, 306] [250, 536]

New EnglandMean cost per client $41 $94 $203 $19895% CI [16, 65] [-76, 265] [70, 337] [44, 352]

North CoastMean cost per client $301 $343 $500 $56495% CI [158, 443] [227, 458] [335, 664] [441, 687]

TotalMean cost per client $301 $349 $411 $46895% CI [196, 406] [247, 451] [315, 508] [392, 544]


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C.8 PHARMACEUTICAL USE AND COSTThe following section provides an analysis of the use of pharmaceutical items by each cohort. The analysis is presented in two parts. The first part (Tables C93-C94) analysis, at a client level, all pharmaceutical items funded to clients. The second part analyses pharmaceuticals prescribed for each of the targeted chronic conditions of the trial. Note: Those designated as ‘IHT (new CVC)’ are those telemonitoring participants who joined CVC immediately prior to commencing the trial. Those designated as ‘IHT (pre CVC)’ are those Telemonitoring participants who were CVC participants for a period of at least three months prior to commencing the trial. For the purpose of this analysis, the targeted pharmaceuticals analysed are condition-specific for the treatment of CAD, COPD, CHF and diabetes. As some clients have been identified with more than one chronic condition, such client will be counted in each of the chronic condition they are associated with.

Table C95: Change in use and cost of all pharmaceuticals

Number and cost of all pharmaceutical

(per quarter)


Number clients 5,756 5,700 2,608 2,596 167 167 -1.0% -0.5% 0.0%Total items per quarter 109,914 97,133 53,858 53,740 3,645 4,110 -11.6% -0.2% 12.7%

Total Cost per quarter $3,466,310

$3,041,768

$1,775,971

$1,782,085 $123,799 $137,857 -12.2% 0.3% 11.4%

Mean items/client/quarter 19.1 21.8 20.7 23.7 21.8 24.9 14.1% 14.8% 14.1%

Mean cost/client/quarter $602 $655 $681 $786 $741 $833 8.7% 15.4% 12.3%


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Table C96: Change in use and cost of all pharmaceuticals- Pre CVC contrasted against new to CVC

Number and cost of optical services (per quarter)



IHT (pre CVC)

Number clients 59 59 108 108 0.0% 0.0%Total items per quarter 1,250 1,324 2,396 2,786 5.9% 16.3%Total Cost per quarter 39,964 41,292 83,835 96,565 3.3% 15.2%Mean items/client/quarter 21.2 22.9 22.2 26.0 8.0% 17.3%Mean cost/client/quarter 677 711 776 899 5.0% 15.8%

Table C97: Percentage change in use and cost of CAD pharmaceuticals

Pharmaceutical use and costs% Change for each cohort between baseline and trial periods

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Number of clients -4.7% -1.6% 0.0% -4.9% 2.5%Total items -17.0% -7.9% 1.5% 14.4% -4.2%Total cost -18.9% -10.1% 1.3% 6.1% -1.1%Mean items per client 5.7% 4.4% 2.4% 21.4% -5.8%Mean cost per client 5.0% 3.9% 2.3% 12.4% -2.3%


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Table C98: Change in use and cost of CAD pharmaceuticals

Pharmaceutical use and costs (per quarter)


Number of clients 3,704 3,529 1,870 1,841 122 122Total items 9,605 7,976 5,019 4,621 303 308Total cost $129,792 $105,324 $67,748 $60,896 $4,196 $4,249Mean items per client 2.6 2.7 2.7 2.8 2.5 2.595% CI [2.5, 2.7] [2.6, 2.9] [2.6, 2.8] [2.7, 2.9] [2.2, 2.8] [2.2, 2.9]Mean cost per client $35 $37 $36 $38 $34 $3595% CI [34, 36] [35, 39] [34, 38] [36, 40] [26, 42] [27, 43]

Table C99: Change in use and cost of CAD pharmaceuticals - Pre CVC contrasted against new to CVC



Number of clients 41 39 81 83Total items 94 108 209 200Total cost $1,377 $1,461 $2,818 $2,788Mean items per client 2.3 2.8 2.6 2.495% CI [1.8, 2.8] [2.2, 3.4] [2.2, 3.0] [2.0, 2.9]Mean cost per client $34 $38 $35 $3495% CI [20, 47] [23, 53] [25, 45] [24, 44]


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Table C100: Percentage change in use and cost of COPD pharmaceuticals

Pharmaceutical use and costs% Change for each cohort between Baseline and Trial data

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Number of clients 3.5% 4.8% 4.5% -8.3% 13.5%Total items -12.2% -3.7% 18.3% 23.7% 15.6%Total cost -19.2% -12.8% 5.3% 3.5% 6.2%Mean items per client 11.0% 9.4% 14.0% 35.3% 2.9%Mean cost per client -1.8% -2.3% 1.6% 13.0% -5.2%

Table C101: Change in use and cost of COPD pharmaceuticals





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Table C102: Change in use and cost of COPD pharmaceuticals - Pre CVC contrasted against new to CVC




Table C103: Percentage change in use and cost of CHF pharmaceuticals

Pharmaceutical use and costs% Change for each cohort between Baseline and Trial data

GCH CVC IHT IHT (new CVC) IHT (pre CVC)Number of clients -3.6% -0.2% 2.7% 4.0% 2.0%Total items -17.2% -7.6% 8.3% 4.8% 10.2%Total cost -28.0% -21.3% -5.9% -12.2% -1.8%Mean items per client 2.8% 4.2% 6.0% 1.5% 8.5%Mean cost per client -12.9% -11.5% -8.0% -14.9% -3.6%


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Table C104: Change in use and cost of CHF pharmaceuticals




Table C105: Change in use and cost of CHF pharmaceuticals - Pre CVC contrasted against new to CVC




Table C106: Percentage change in use and cost of diabetes pharmaceuticals

Pharmaceutical use and costs % Change for each cohort between Baseline and Trial data


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GCH CVC IHT IHT (new CVC) IHT (pre CVC)Number of clients -3.4% -0.9% 8.7% 0.0% 17.4%Total items -6.4% -1.9% 19.8% 12.9% 26.8%Total cost -1.5% 0.5% 0.5% 7.2% -5.9%Mean items per client 7.7% 8.8% 11.2% 14.9% 8.0%Mean cost per client 16.0% 13.2% -6.5% 9.5% -19.8%

Table C107: Change in use and cost of Diabetes pharmaceuticals



Number of clients 1,083 1,046 559 554 46 50Total items 2,601 2,434 1,327 1,302 129 155Total cost $118,069 $116,309 $63,297 $63,606 $6,832 $6,869Mean items per client 2.4 2.6 2.4 2.6 2.8 3.195% CI [2.3, 2.5] [2.5, 2.7] [2.2, 2.5] [2.4, 2.8] [2.2, 3.4] [2.5, 3.8]Mean cost per client $109 $127 $113 $128 $149 $13995% CI [100, 118] [115, 138] [99, 127] [113, 143] [93, 204] [96, 182]


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Table C108: Change in use and cost of Diabetes pharmaceuticals - Pre CVC contrasted against new to CVC

Pharmaceutical use and costs (per

quarter)




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DAPPENDIX D – AQOL 8D QUESTIONS AND

ANALYSISThe AQoL-8D survey (a 35 question self-report tool) has been used to seek information from respondents on eight different health dimensions: independent living, happiness, mental health, coping, relationships, self-worth, pain and senses.

The result is used to calculate an overall ‘utility score’ for groups of respondents to compare to other groups (e.g. control groups) as well as measure change or impact over time. In addition, for each dimension a value can be generated that enables comparison over a time series.

The AQoL 8D survey has been undertaken with trial participants and the matched control group on commencement of the trial, at an interim point between 6-12 months later depending on the trial commencement point for the participant, and at completion of the trial. The matched control group were sent their final survey at the end of the trial in October to November 2016.

The following provides the AQoL-8D questionnaire and summary results from the surveys distributed and analysed.

D.1 AQOL-8D QUESTIONS AND DIMENSIONS

Independent Living

1. How much help do you need with jobs around the house (e.g., preparing food, cleaning the house or gardening)?

I can do all these tasks very quickly and efficiently without any help I can do these tasks relatively easily without help I can do these tasks only very slowly without help I cannot do most of these tasks unless I have help I can do none of these tasks by myself

2. Thinking about how easy or difficult it is for you to get around by yourself outside your house (e.g., shopping, visiting):

Getting around is enjoyable and easyI have no difficulty getting around outside my houseA little difficultyModerate difficultyA lot of difficultyI cannot get around unless somebody is there to help me


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3. Thinking about your mobility, including using any aids or equipment such as wheelchairs, frames, sticks:

I am very mobile I have no difficulty with mobility I have some difficulty with mobility (for example, going uphill) I have difficulty with mobility. I can go short distances only. I have a lot of difficulty with mobility. I need someone to help me. I am bedridden

4. Thinking about washing yourself, toileting, dressing, eating or looking after your appearance:

These tasks are very easy for me I have no real difficulty in carrying out these tasks I find some of these tasks difficult, but I manage to do them on my own Many of these tasks are difficult, and I need help to do them I cannot do these tasks by myself at all

Senses

5. Thinking about your vision (using your glasses or contact lenses if needed):I have excellent sight I see normally I have some difficulty focusing on things, or I do not see them sharply, e.g. small print, a newspaper or seeing objects in the distance. I have a lot of difficulty seeing things. My vision is blurred. I can see just enough to get by with. I only see general shapes. I need a guide to move around. I am completely blind

6. Thinking about your hearing (using your hearing aid if needed):I have excellent hearing I hear normally I have some difficulty hearing or I do not hear clearly. I have trouble hearing softly-spoken people or when there is background noise. I have difficulty hearing things clearly. Often, I do not understand what is said. I usually do not take part in conversations because I cannot hear what is said. I hear very little indeed. I cannot fully understand loud voices speaking directly to me. I am completely deaf

7. When you communicate with others, e.g. by talking, listening, writing or signing:I have no trouble speaking to them or understanding what they are saying I have some difficulty being understood by people who do not know me.I have no trouble understanding what others are saying to me I am understood only by people who know me wellI have great trouble understanding what others are saying to meI cannot adequately communicate with others


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Pain

8. Thinking about how often you experience serious pain. I experience it: Very rarely/Less than once a week/Three to four times a week/Most of the time.

9. How much pain or discomfort do you experience? None at all/ Moderate pain/ Severe pain/ Unbearable pain

10. How often does pain interfere with your usual activities? Never/ Almost never/ Sometimes/ Often/ Very often/ Always

Mental Health

11. How often do you feel depressed? Never/ Almost never/ Sometimes/ Often/ All the time

12. How often do you have trouble sleeping? Never/ Almost never/ Sometimes/ Often/ All the time

13. How often do you feel angry? Never/ Almost never/ Sometimes/ Often/ All the time

14. Do you ever feel like hurting yourself? Never/ Rarely/ Sometimes/ Often/ All the time

15. How often did you feel in despair over the last seven days? Never/ Occasionally/ Sometimes/ Often/ All the time

16. And still thinking about the last seven days, how often did you feel worried? Never/ Occasionally/ Sometimes/ Often/ All the time

17. How often do you feel sad? Never/ Rarely/ Sometimes/ Often/ Always

18. When you think about whether you are calm and tranquil or agitated, I am:Always calm and tranquilUsually calm and tranquilSometimes calm and tranquilSometimes agitatedUsually agitatedAlways agitated

Happiness

19. How content are you with your life? Extremely/ Mainly/ Moderately/ Slightly/ Not at all

20. How enthusiastic do you feel? Extremely/ Very/ Somewhat/ Not much/ Not at all

21. How often do you feel happy? All the time/ Mostly/ Sometimes/ Almost never/ Never

22. How often do you feel pleasure? Always/ Usually/ Sometimes/ Almost never/ Never


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Self-worth

23. How much of a burden do you feel you are to other people? Not at all/ A little/ A moderate amount/ A lot/ Totally

24. How often do you feel worthless? Never/ Almost never/ Sometimes/ Usually/ Always

25. How much confidence do you have in yourself? Complete confidence/ A lot/ A moderate amount/ A little/ None at all

Coping

26. Thinking about how much energy you have to do the things you want to do, I am:Always full of energyUsually full of energyOccasionally energeticUsually tired and lacking energy/ Always tired and lacking energy

27. How often do you feel in control of your life? Always/ Mostly/ Sometimes/ Only occasionally/ Never

28. How much do you feel you can cope with life’s problems? Completely/ Mostly/ Partly/ Very little/ Not at all

Relationships

29. Your close relationships are: Very satisfying/ Satisfying/ Neither satisfying nor unsatisfying/ Dissatisfying/ Unpleasant/ Very unpleasant

30. How much do you enjoy your close relationships (family and friends)? Immensely/ A lot/ A little/ Not much/ I hate it

31. How often do you feel socially isolated? Never/ Rarely/ Sometimes/ Often/ Always

32. How often do you feel socially excluded or left out? Never/ Rarely/ Sometimes/ Often/ Always

33. Your close and intimate relationships (including any sexual relationships) make you: Very happy/ Generally happy/ Neither happy nor unhappy/ Generally unhappy/ Very unhappy

34. Thinking about your health and your relationship with your family:My role in the family is unaffected by my healthThere are some parts of my family role I cannot carry outThere are many parts of my family role I cannot carry outI cannot carry out any part of my family role


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35. Thinking about your health and your role in your community (that is to say neighbourhood, sporting, work, church or cultural groups):

My role in the community is unaffected by my healthThere are some parts of my community role I cannot carry outThere are many parts of my community role I cannot carry outI cannot carry out any part of my community role

D.2 AQOL-8D – POPULATION NORM SCORES The table below provides the unweighted AQoL 8D norm scores for the Australian 65-74 age group that can be used to compare with the norm scores derived for the IHT participants and matched control group.

Table D1: AQoL 8D norm score by Dimension

Dimension Norm score (mean)Independent living 88.14Happiness 75.46Mental health 79.51Coping 77.19Relationships 85.83Self-worth 86.17Pain 78.1Senses 83.56Overall utility score 82.01

Source: Centre for Health Economics

D.3 RESPONSE RATES TO AQOL 8D SURVEYSThe table below provides the survey response rates for completion of the AQoL 8D survey.

Table D2: AQoL 8D norm score by Dimension – IHT participants, control group

AQoL 8D Dimension

IHT Baselin

e

IHT Interim

IHT Post trial

Control Baseline

Control Interim

Control Post-trial

Independent. Living 226 124 171 304 178 167Happiness 226 124 171 305 178 168Mental Health 225 124 171 305 178 168Coping 223 122 171 303 178 168Relationships 223 121 171 304 176 168Self-worth 223 120 169 300 174 166Pain 222 120 171 304 176 168Senses 222 120 171 302 175 168Utility Score (valid n) 220 119 169 296 173 165


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D.4 RESPONSES TO AQOL 8D SURVEYSThe following figures provide the scores for the AQoL 8D overall and for each domain. It contrasts the IHT cohort between baseline, interim and post-participation surveys and compares this to the results for matched control group. The baseline survey was provided to the participant on commencement, the interim survey was distributed in June 2015. Post participation surveys were sent to participants as they withdrew and at the end of the trial. The matched control group were sent surveys at the end of the trial (October to November 2016).

Figure D1: AQoL-8D utility scores – IHT participants, control group and ‘population norm’

Figure D2: Independent living scores – IHT participants, control group and ‘population norm’


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Figure D3: Happiness scores – IHT participants, control group and ‘population norm’

Figure D4: Mental health scores – IHT participants, control group and ‘population norm’


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Figure D5: Coping scores – IHT participants, control group and ‘population norm’

Figure D6: Relationship scores – IHT participants, control group and ‘population norm’


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Figure D7: Self-worth scores – IHT participants, control group and ‘population norm’

Figure D8: Pain scores – IHT participants, control group and ‘population norm’


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Figure D9: Senses scores – IHT participants, control group and ‘population norm’

D.5 SIGNIFICANCE TESTINGStatistical significance testing was undertaken using the unweighted AQoL scores using EpiTool software. The following table provides a summary of the results.

Table D3: AQoL 8D-summary of statistical significance testing

Significance test (two tailed t-test) Conclusion

Control v. Trial group at baseline Not significantly different

Control v. Trial group at interim Difference between the means (trial group closer to population norm)

Control v. Trial group at post-participation Not significantly different

Baseline v. Interim for trial group Not significantly differentInterim v. Post-participation for trial group Not significantly different

Baseline v. Post-participation for trial group Not significantly different


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EAPPENDIX E – KESSLER 10 QUESTIONS

AND ANALYSISThe Kessler-10 questionnaire is a tool that gives an indication of likely mental health status, in particular levels of stress / distress, based on self-assessment by the respondent. The tool does not in itself diagnose mental health conditions but is a useful self-reporting reference tool for clinicians to understand how the patient is feeling.

The survey asks 10 questions of the respondents seeking information from tiredness, nervousness, restlessness and self-worth. It asks the respondent to consider how they felt ‘in the last four weeks’ when answering those questions before giving a five-point standardised answer ranging from ‘none of the time’ through to ‘all of the time’. Using a Likert scoring model, a total score of likely mental wellbeing status can be calculated.

The K10 survey has been undertaken with trial participants and the matched control group on commencement of the trial, at an interim point between 6-12 months later depending on the trial commencement point for the participant, and at post-participation. The matched control group received the survey at the end of the trial (October to November 2016). The following provides the K10 questionnaire and the summary results from the three surveys distributed.

E.1 K10 QUESTIONS

1. In the last four weeks, about how often did you feel tired out for no good reason?

None of the time

A little of the time

Some of the time

Most of the time All of the time

□ □ □ □ □

2. In the last four weeks, about how often did you feel nervous?

None of the time


Some of the time


□ □ □ □ □

3. In the last four weeks, about how often did you feel so nervous that nothing could calm you down?

None of the time


Some of the time


□ □ □ □ □


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4. In the last four weeks, about how often did you feel hopeless?

None of the time


Some of the time


□ □ □ □ □

5. In the last four weeks, about how often did you feel restless or fidgety?

None of the time


Some of the time


□ □ □ □ □

6. In the last four weeks, about how often did you feel so restless you could not sit still?

None of the time


Some of the time


□ □ □ □ □

7. In the last four weeks, about how often did you feel depressed?

None of the time


Some of the time


□ □ □ □ □

8. In the last four weeks, about how often did you feel that everything was an effort?

None of the time


Some of the time


□ □ □ □ □

9. In the last four weeks, about how often did you feel so sad that nothing could cheer you up?

None of the time


Some of the time


□ □ □ □ □

10. In the last four weeks, about how often did you feel worthless?

None of the time


Some of the time


□ □ □ □ □


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E.2 RESPONSE RATES TO K10 AT BASELINE AND INTERIM REPORTINGThe table below provides the total number of K10 surveys analysed for each cohort and survey point.

Table E1: K10-Summary of results

Trial group (Baseline)

Trial group (Interim)

Trial group (Post)

Control Group

(Baseline)

Control Group

(Interim)

Control Group (Post)

211 110 155 280 164 148

The following figures provide the scores for the K10 overall and for each question. It contrasts the IHT cohort and control group over the reporting periods (baseline, interim and post-participation).

Figure E1: Average K10 scores


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Figure E2: Proportion of respondents per K10 category

Figure E3: How often did you feel tired for no good reason?


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Figure E4: How often did you feel nervous?


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Figure E5: Felt so nervous nothing could calm you down?

Figure E6: How often did you feel hopeless?


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Figure E7: How often did you feel restless or fidgety?

Figure E8: So restless could not sit still?


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Figure E9: How often did you feel depressed?

Figure E10: How often did you feel that everything was an effort?


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Figure E11: So sad that nothing could cheer you up?

Figure E12: How often did you feel worthless?


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FAPPENDIX F – PARTICIPANT SURVEY

ANALYSISParticipants were provided an opportunity to feedback about their expectations and experiences during the trial, through a participant survey. The survey was distributed at the commencement of the trial, an interim period (6-12 months after trial commencement), and again at the end of their trial experience.

F.1 PARTICIPANT SURVEY QUESTIONSSurvey questions differed based on expectations (pre-participation) and experience (interim and post-participation). The following are the questions from the interim and post participation survey. Note that an additional set of questions were asked of participants completing the whole trial (beyond September 2016) in order to evaluate the end of trial processes, these additional questions are also specified below. Post-participation survey responses have been combined for those who withdrew early, and for those continuing until the end of the trial for the majority of the analysis. A separate analysis of withdrawn participants at post-participation is provided below, with further analysis provided in the main report. An analysis of the reasons for continuing on until the end of the trial is provided below.

1. What has been your overall experience with the trial equipment:

Very Poor Poor Satisfactory Good Very Good

2. Please rate how easy the telemonitoring equipment is to use without assistance:

Very difficult Difficult OK Easy Very Easy Did not use

1. Putting my information into the Tablet (computer) was: □ □ □ □ □□

2. Using the Blood Pressure cuff was: □ □ □ □ □□

3. Using the Pulse Oximeter was: □ □ □ □ □ □

4. Using the Blood Sugar Device (glucometer) was: □ □ □ □ □□

5. Using the Lung monitor (spirometer) was: □ □ □ □ □□

6. Using the Weight Scale was: □ □ □ □ □□

7. Using the Thermometer was: □ □ □ □ □□


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8. Conducting a Videoconference was: □ □ □ □ □□


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3. At any time during your participation in telemonitoring, did you need help with the technology from Tunstall Healthcare?

□ Yes (please continue to question 4)

□ No (please continue to question 7)

4. Please rate the quality of help provided by Tunstall Healthcare

Very Poor Poor Satisfactory Good Very Good

5. When you needed help with the telemonitoring technology, did you get it quickly?

□ Yes

□ No

6. How useful was the help you received?

Not at all useful Somewhat useful Satisfactory Good Very Good

7. At any time during your participation in telemonitoring, did you need help with the technology from a carer?

□ Yes

□ No

8. Do you feel that you have a better understanding of your condition as a result of participating in the telemonitoring trial?

□ Yes

□ No

9. Do you feel that you have had more say in how your health care needs are managed as a result of participating in the telemonitoring trial?

□ Yes

□ No

10. Do you feel that using the telemonitoring equipment has assisted you to seek help with your health care needs?

□ Yes

□ No


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11. As a result of the telemonitoring trial, please indicate what has changed in relation to your level of contact with your Practice Nurse by selecting ‘more’, ‘about the same’, or ‘less’.

More About the same Less I don’t have a Practice Nurse

My face to face contact with the Practice Nurse □ □ □ □

My telephone/video/online contact with the Practice Nurse □ □ □ □

My overall contact with the Practice Nurse □ □ □ □

12. As a result of the telemonitoring trial, please indicate what has changed in relation to your level of contact with your GP by selecting ‘more’, ‘about the same’, or ‘less’.

More About the same Less

My face to face contact with the GP □ □ □

My telephone/video/online contact with the GP □ □ □

My overall contact with the GP □ □ □

13. Has your contact with health care providers other than your GP/Practice nurse changed as a result of participating in telemonitoring?

□ Yes (please continue to question 14)

□ No (please continue to question 15)

14. Please select your answer to one of the following:

□ I have more contact with other health care providers as a result of Telemonitoring

□ I have less contact with other health care providers as a result of Telemonitoring

15. Overall, do you feel that using telemonitoring equipment has improved your general well-being?

□ Yes

□ No

16. Please select which of the following statements apply to you:

□ I like using the telemonitoring equipment to monitor my health

□ It takes a lot of time to take all the measurements I am required to


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□ I need a lot of help from my carer or another person to take my measurements /use the equipment

17. Please select how frequently you use the following technologies in your life:

Daily Weekly Monthly never

Personal computer (desktop, laptop, tablet) □ □ □ □

Mobile telephone □ □ □ □

Internet (apart from when using telemonitoring) □ □ □ □

Automatic Teller Machine (ATM) □ □ □ □

18. Would you recommend telemonitoring to family and friends for managing their healthcare?

□ Yes

□ No

19. What do you consider to be the best things about telemonitoring for you? (select all that apply)

□ More convenient for me

□ More convenient for the person who cares for me

□ Saves me money on my healthcare

□ Saves me time attending to my healthcare needs

□ Saves my carer time attending to my healthcare needs

□ Gives me reassurance that my healthcare is being attended without attending the GP

□ I feel more relaxed about my health state

□ None of the above

20. Overall, do you feel that using telemonitoring equipment in your home has improved your quality of life?

□ Yes

□ No

21. Did you have help from anyone to complete this survey?

□ Yes

□ No


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Additional questions for participants continuing the end of the trial:

22. Overall, do you feel that using telemonitoring equipment led to a better understanding of your health?

□ Yes

□ No

23. Overall, do you feel that using telemonitoring equipment led you to change your lifestyle (e.g. diet, exercise)?

□ Yes

□ No

24. Overall, do you feel that using telemonitoring equipment improved the way you manage your health (e.g. taking medication, talking about your condition with your nurse or GP, managing your symptoms)?

□ Yes

□ No

25. What was the main reason you have continued on the trial until now?

□ I want to manage my health better

□ I enjoy the reassurance or peace of mind of having my health monitored regularly

□ I enjoy the social contact with my practice nurse or Tunstall

□ I want to support DVA to help other veterans

□ My family have encouraged me to remain on the trial

□ My GP and nurse have encouraged me to remain on the trial

□ Other - please provide detail below:

26. Do you have any other feedback on your experience on the telemonitoring trial (e.g. concerns, benefits, areas for improvement)? Please specify below:

(Blank Box for free text)


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F.2 RESPONSE RATESThe table below provides the total number of participant surveys analysed for each cohort and survey point. Response rates varied slightly for each (74% and 78%). Table F1 also details the proportion of respondents that had assistance providing their response.

Table F1: Number of respondents and proportion who had assistance for each participant survey

Baseline Interim PostNumber of responses 218 130 173% responses with assistance

19% 10% 10%

The following analysis provide a summary of the participant surveys and changes over time.

F.3 EXPECTATIONS FROM PARTICIPATIONAt the pre-trial stage, the participation survey asked each participant what they wanted to achieve from the trial. A response to this question was received from all 218 survey respondents with the top responses being; “a better understanding of my condition” followed by “feel more relaxed about my health state”, “convenient health care for me” and “improve my general wellbeing” (see Figure F1). Whilst 53% had expectations of convenient healthcare, only 30% expected that monitoring would save them time. Similarly, very few expected to save on health care costs, due to the available DVA subsidy.

Figure F1: What trial participants expected to achieve from the trial (pre-participation)


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Figure F2: Views of participation in the trial (%)

Respondents then recorded the best things about telemonitoring at interim and post participation, Table F2 below. These responses suggest that quality of life had improved more significantly than expected (from baseline to interim). Respondents also felt more relaxed at interim than expected (at pre-participation), but this decreased slightly by the end of the trial. It is noted however, that a feeling of reassurance remained relatively high across the interim and post participation surveys. We note that only a very small proportion (5% at interim, 3% at post participation) felt that none of the options provided were relevant to any perceived benefit.

As Table F2 indicates, much of the perceived benefits were more significant from baseline to interim than they were from baseline to post participation, suggesting that benefits were more significant over a shorter term or that the baseline expectation had shifted after starting on the trial.

Table F2: Perceived benefits of the telemonitoring trial at interim and post participation

Experienced benefit to participant Interim Post% Change (interim to

post)More convenient for me 58% 48% -17%More convenient for carer 25% 25% 0%Saves money on healthcare 10% 12% 20%Saves me time attending my healthcare needs 28% 26% -7%Saves carer time attending to my healthcare needs 9% 8%

-11%

Gives reassurance 79% 65% -18%I feel more relaxed 66% 47% -29%Improved quality of life 76% 66% -13%I have a better understanding of my condition 91% 79% -13%I have more say in how my healthcare needs managed 78% 64%

-18%

Has assisted me to seek help with healthcare 84% 64% -24%


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needsImproved overall general wellbeing 85% 67% -21%

Other perceived benefits included:

91% respondents in the interim survey felt they had a better understanding of their condition as a result of participating in the trial, but this decreased to 79% post participation

78% participants at the interim survey felt they had more say in how their health care needs were managed as a result of the trial (at post participation, this was 64%)

participants were asked if the telemonitoring had led to an improvement in their general wellbeing. For the interim survey 85% respondents agreed but for the post trial survey this was 67%. This is an increase compared to the 53% expecting improved general wellbeing as the trial commenced.

F.4 USE OF EQUIPMENTThere were initial concerns regarding participants’ capacity to manage the trial’s technology, given the aged cohort. A key finding is that most have managed the technology with limited difficulty and this has not been a barrier to participation. Some participants were initially anxious about using the equipment until the service provider provided training and installation. Figure F3 details the overall experience of using the equipment at interim and post participation.

Figure F3: Overall experience using the telemonitoring equipment

Key findings regarding use of equipment include:

89% of post participation respondents rated their overall experience with the equipment as either ‘satisfactory’ (15%), ‘good’ (25%) or ‘very good’ (49%). For the interim survey, this was 97%

prior to the commencement of the trial, 77% of participants thought they would like to use the telemonitoring equipment to monitor their health, and post participation 76% of participants reported liking using the telemonitoring equipment

pre-trial, 5% of respondents, were concerned about the amount of time it might take to record all the measurements and post participation, 10% reported it took a lot of time to take all the measurement required

pre-trial, 8% of respondents expected to need a lot of help from carer or another person to take measurements / use the equipment with 9% post-participation respondents needing help


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84% felt the telemonitoring equipment assisted them in seeking help with health care needs at the interim period (falling to 67% post trial)

Approximately 85% of participants expressed no concern pre-trial with being able to use the telemonitoring equipment. The majority of pre-trial participants thought it would be okay- easy (61%) to enter data onto the tablet and reported post trial that is was easy to very easy (71%). Using the measuring equipment overall was thought to be okay – very easy by 91% of pre-trial participants.

Findings for assessing the level of difficulty for using the specific equipment (for those respondents using them) is provided below in Figures F4 to F7. Note that questions regarding specific monitoring equipment were only provided in the interim and post participation surveys. At the end of the trial participants found the use of the blood pressure equipment to be easy-very easy (80%), pulse oximeter easy-very easy (69%), and for weight scales, 80% found it easy-very easy. Over half of the post-trial participants had not used the blood sugar device, spirometer or thermometer instruments, and of those that did the majority reported their use as very easy. Regarding the spirometer, for those that did use it, 78% (interim) and 88% (post participation) found it easy or very easy to use.We note also, that the thermometer was deemed superfluous for many participants based on feedback from the service provider.

Figure F4: Participant’s perceived level of difficulty for using tablet


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Figure F5: Participant’s perceived level of difficulty for using blood pressure cuff

Figure F6: Participant’s perceived level of difficulty for using pulse oximeter


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Figure F7: Participant’s perceived level of difficulty for using blood sugar device (glucometer)

From the interim participant survey, 88% reported seeking assistance to use the equipment from the service provider and 84% at post participation. There were only 18-20% who sought help from a carer to use the equipment. Of those seeking assistance from the service provider:

over 75% of participants reported the quality of the help as good to very good 91% (interim) and 84% (post trial) of respondents reported they got help quickly 84% of post participation responses indicated the help provided was useful.

F.5 USE OF OTHER TECHNOLOGYThe pre-participation survey found that between 24% and 35% of participants have never used a personal computer, mobile telephone, the internet or an automatic teller machine (ATM). This rate did not change over the period of the trial nor was there a change in the frequency of use of other technology for those that did use technology occasionally.

At commencement of the trial, 11% of respondents had little concern about using the video-conferencing technology, and for the interim and post participation surveys, only 3% of participants expressed concern. It is noted also that 18% at interim and 22% at post participation did not use the videoconferencing technology. Figure F8 details the level of difficulty in using the videoconferencing function without assistance.


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Figure F8: Participant’s perceived level of difficulty for using videoconference (interim and post)

F.6 HEALTH CARE SUPPORTTrial participants were asked to report on any changes to the level of contact they perceived they had with their practice nurse, their GP and other health professionals. Participants post trial reported about the same amount of overall contact with their practice nurse at 43% (similar for face to face and online) and 29% reported more contact. For overall contact with GP, 64% reported it to be about the same and 13% had more overall contact (this reflected more face to face time than online time).

Of note, 10% of pre-participation respondents ‘did not have a practice nurse’, this increased to 12% at the interim period and 16% at post-trial.

In relation to other health professional contact, 78% reported no change in contact (at post participation), and of those who have reported a change this was relatively evenly distributed between more contact and less contact. This finding was similar to the interim survey findings. We note that utilisation of other health services (e.g. community nursing, allied health) is generally low in the trial group.

Figures F9 to F4 detail the expectations at the trial commencement (baseline) and the experiences at interim and post participation for changes in contact with health professionals.


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Figure F9: Changes in face to face contact with practice nurse

Figure F10: Changes in video/telephone contact with practice nurse


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Figure F11: Changes in overall contact with practice nurse

Figure F12: Changes in face to face contact with GP


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Figure F13: Changes in video/telephone contact with GP

Figure F14: Changes in overall contact with GP

F.7 OVERALL EXPERIENCEIn order to assess overall trial experience, participants were asked about the likelihood of recommending the technology (and trial model), and the overall impacts on quality of life. In response to the question of whether they would recommend telemonitoring to their family or friends, 93% of respondent in the interim survey agreed they would recommend the use of telemonitoring to family and friends for the post trial survey it was 80%.The participants were also asked whether they felt using the telemonitoring equipment had improved their quality of life. Overall at interim survey, 76% of respondents reported that using telemonitoring equipment in their home improved their quality of life, and post-trial it was 66%.Findings such as these – i.e. improved experiences from baseline (pre-trial) to interim, with less improvement (either plateau or decrease) at post participation may indicate a ‘changing baseline’, and that the trial model lends itself to early improvements and Appendices to Final reportAugust 2017

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impacts (e.g. stabilization and management of condition, medication adjustment, health literacy), rather than long term changes on the use of services.

F.8 CONTINUATION UNTIL THE END OF THE TRIALAs discussed above, a number of questions were added to the post participation survey for those that continued to the end of the trial (beyond September 2016). Analysis of the additional questions exclusive for those who continued past September 2016 through the step-down process are provided in Table F3 and below.

In general, a little more than half of the respondents felt the trial had improved their ability to manage their condition and understand and control their health. Slightly more than half believed the trial led to a change in lifestyle (e.g. improved diet or exercise regime). Almost 80% felt that the trial had improved their own health management (e.g. medication management, communication with their health professional, and managing symptoms).

Table F3: Summary of experiences for participants continuing to end of trial

ExperiencePercenta

ge (n=113)

I felt I could manage my condition better 50%I felt the trial gave me more control of my health 59%Led to a better understanding of my health 58%Led me to change my lifestyle (e.g. diet, exercise) 54%Improved my health management (meds, communication, managing symptoms)

79%

At the conclusion of the trial participants were asked for the main reasons for continuing on the trial to the end. These responses are shown in the figure below, noting more than one response was allowed. The most common reasons for continuing were cited as supporting DVA to help other veterans into the future (73%), and participant reassurance and peace of mind that monitoring brings them (73%), followed by encouragement from practice staff. Thirty five percent of respondents cited that social contact with the practice and the service provider was an important factor.

This provides evidence for how important it is to veterans to support the health and wellbeing of their fellow veteran community. It also reiterates the key findings from practice surveys and case studies that the monitoring is reassuring participants about their health and health risks on a regular basis (to reduce anxiety). Encouragement from practice staff to continue, supports the theory that the ‘coaching’ element of practice and patient relationships is important and effective. It is also evident that social contact is an important factor for this cohort, potentially due to isolation from family and friends as the participants age or become less mobile, or family and friends move away.


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Figure F15: Reasons for continuing until end of trial

‘Other’ reasons for continuing the trial (n=11) were most frequently related to maintaining and managing health, and support for faster treatment and health management.

Other feedback on trial experiences were collected by free text. These have been categorised by theme in Figure F16. A range of quotes are also provided below.

Figure F16: Summary of other feedback (Q26) for participants continuing to end of trial


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Selected comments from participants who continued to end of trial:

Peace of mind and reassurance:

“having had one heart attack, the trial satisfied and reassured me that all was well. Often one can have a pain in the chest, shoulder, arm and question is "it a heart attack?" The frequently monitored ECG gave me confidence not to panic but watch for more symptoms”

“during the time of the trial I was fitted with a pacemaker. Consequently, the service provider added an ECG Reader to my regime. I found this to be a great help to my confidence and peace of mind. This resulted in medication reduction that might not have been picked up as quickly. I would like the monitoring to continue”

“whilst travelling Australia it gives me reassurance and peace of mind on how my health is going”

“the trial has been like a health security blanket. I feel I would have visited the doctor more regularly, if it had not been for the trial”

“I think that the telemonitoring should continue. I felt safe that other people were watching”

“not having a computer, I found it a little difficult to become familiar with using the various things but the help I needed was only a phone call away and everyone was very easy to talk to and explained patiently step by step and talked me through it all. Quite a few times my doctor and the nurse at the clinic were quick to call me if there were concerns about things, blood pressure etc. One call reflected in a trip to hospital with the need for angioplasty and a stent inserted. So, thanks for telemonitoring. I can only add that living alone, it gave me more assurance that someone out there, cares”

“I am very fortunate to live with my partner who is, like me, 87 years old. We are both in fairly good health and look after each other while having quite active lifestyles. These telemonitoring trial tests are especially important for patients living alone as they give a great feeling of security, knowing there is someone to call on, who knows you personally, to assist with any emergency or serious health problems”.

Valuable to health:

“the trial made you take the necessary health readings that you sometimes tend not to do on a regular basis. I enjoyed the trial and it made me take more care on my diet to ensure my sugar levels are maintained”

“I feel that a very important daily check of my health check has been ceased by the trial being stopped. Hoping that DVA will commence the telemonitoring evaluations survey again in the near future”

“great program. Pleased to be part of it. It may have, in conjunction with my Tunstall nurse, saved my life”

“I think that anyone who is previously ill would benefit from having this equipment in their home & at their disposal. So far, I am of sound mind and enjoy reasonably good health for my age. I wish to thank you good people for all your caring & assistance”

“I found what was asked of me very good, I had thought I would not be of any use. Being old, these modern devices come hard for the older people to cope with. I was able to see some of my problems, and learn to accept things happening that come up. Also, the help - the nurses at Tunstall were a real gem for the way they took an interest in me, plus it was great when they rang to update me on my problems. I was very much looked after in every way possible. A credit to all staff”


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“it has enabled me to monitor oxygen saturation - I need to use nebuliser and different medication for asthma and when not improved, to call ambulance, or act when temperature flares. One flare - really bad within the trial - turned out to be pneumonia hence long stay in hospital twice. The doctor organised medication so it was available at home (nebuliser and 3 different medications) as I now need to maintain care at home with home visits”.

The service provider staff were helpful:

“I found sometimes the equipment played up. But when I rang Tunstall, they were very good in fixing my problems quickly. I found the nurses at Tunstall very responsive to my needs. A pity the service stopped. I found it most helpful with my condition”.

Improved my lifestyle:

“I have recently returned the Tunstall equipment. If I would have been able to I would have kept it. It gave me a lot of feedback in relation to my diet and what foods to eat to control my diabetes type 2. I also found, as I also attend a gym through DVA, how important exercise was in this area”.

Other:

“in terms of dollars for value, I do not believe the trial will ever be tax payer cost-effective. In my case, it was a waste of government money”

“battery changing very difficult on some equipment which was hard to open. Connectivity Issues - some equipment would not transmit directly, had to be entered manually”

“some equipment did not work as reliably as I would have liked. I stopped using the oximeter because frequently I could not get a reading”.

F.9 PARTICIPATION EXPERIENCES OF THOSE WHO WITHDREW EARLYAn analysis of 58 responses of participants who left early, presented in an earlier interim report, indicated:

the most common expectation of the participants prior to commencement on the trial was that they would have a better understanding of their condition (61%). The post-trial responses indicated that 63% of participants achieved that expectation

from the pre-trial survey, 31% of participants anticipated that they would have more say in how their health care needs were managed. The post survey results exceeded that expectation with 41% having felt they had more say in their own health care

the post-trial survey indicated that 45% of participants felt the trial assisted them to seek help for their health care needs. This was an improvement on the 39% who anticipated this to be an outcome prior to involvement

while 26% of participants expected to have more contact with their practice nurse as a result of participation, only 15% experienced more contact. 67% anticipated that the contact would be about the same and 74% experienced a similar amount of contact

in relation to GP contact, 14% of trial participants expected to have more, however, 12% had less contact, none had more contact and 88% experienced about the same level of contact

prior to commencement, 53% believed that they would experience improvements to their general wellbeing as a result of participation, however, only 38% reported


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improvement in their wellbeing. This may have impacted participants’ decision to opt out of the trial. That is, whilst being categorised as not wanting to participate in the trial extension, it is possible that “no perceived change or improvement to date” was a factor in that decision. We note that non-technical and health related withdrawal reasons for this analysis group are most common

in response to the question of what was the best thing about participating in the trial, 34% responded with ‘reassurance’ (or peace of mind). Prior to involvement, 56% of the participants anticipated to feel more relaxed about their health care.

Table F4: Reasons for ceasing on trial (Source: Tunstall)

Reason for ceasing on trial Percentage (of 58)

Patient opt-out – non-technical related 48%Patient opt-out - issue/s with technology 19%Did not want to continue with the trial extension 17%Patient moved out of area (outside trial location) 7%Improved health - service no longer required 2%Other: palliative care 3%Patient moved out of area 2%Third party opt-out 2%


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GAPPENDIX G – PRACTICE SURVEY

ANALYSISAn online survey was distributed to 55 practices involved in the Evaluation of In-Home Telemonitoring for Veterans’ trial in October 2015 (the interim practice survey) and a post-participation practice survey was administered from January to April 2017. All practice staff involved in the trial were encouraged to provide a response. Forty-nine complete and 18 partial interim survey responses from 35 practices were submitted and analysed. This data has been compared to 21 complete and 8 partial post-participation surveys from 24 practices at the end of the trial. This indicates a decrease in overall practice response rate from 64% at interim, to 47% at post participation. HOI theorises this reduction in response rate could reflect high practice staff turnover, administration of survey during a popular leave period (school holidays), and a reduction in engagement with the trial after participants were decommissioned. It should also be noted, that although the response rate for the post-trial survey was significantly lower, most respondents provided more detailed answers, providing a rich qualitative data set. The survey questions and analysis of data from the interim and post participation practice surveys are described below.

G.1 DEMOGRAPHIC DATAInitial identifying data was collected to determine the spread of responses. Table G1 summarises the position of survey respondents that completed the surveys.

Table G1 Practice survey respondents, by role

PositionInterim practice survey Post-trial survey

(n=67) % of n (n=28) % of nAdministration 2 2.99% 0 -GP 14 20.90% 0 -Practice Manager 9 13.43% 4 14.30%Practice Nurse 42 62.69% 24 85.70%

More practice nurses proportionally completed the survey on both occasions which most likely reflected their operational role within the trial. No GPs or administration staff completed the post-trial practice survey.

Table G2 shows the number and distribution of practices and respondents that participated in the practice surveys by trial region.


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Table G2: Number of survey participants per practice, by region

Region Response to interim survey Response to post-trial survey# Practices

(n=35)#

Respondents (n=67)

# Practices (n=24)

# Respondents

(n=28)Darling Downs 6 16 4 5North Coast NSW 14 19 9 10New England 5 8 2 2Bayside 10 24 9 11

A large medical centre in the Darling Downs region had the highest number of participants in the interim survey with eight survey participants, followed closely by large medical clinic in the Bayside region with seven. Neither of these practices completed the post-trial practice survey. Of the 24 different practices that completed the post-trial survey, only four practices submitted more than one survey response, two practices in the Bayside region, one in the North Coast region and one in the Darling Downs region.

Approximately 90% of surveyed practices were participating in the Coordinated Veteran Care (CVC) Program before the trial as reported in the interim and post participation surveys. Table G3 describes the maximum number of trial participants enrolled across the period of the trial. The most common number of participants was 1-5, at the interim and post-participation surveys. At interim, 44% respondents (n=66) indicated they had 1-5 participants, compared to 67.7% (n=28) for post-trial survey. This is in line with the early withdrawal of participants between October 2015 and the end of 2016. Six to ten trial participants were registered as the second most common finding in both surveys. Note that one practice indicated at the interim survey that their practice had 21 participants on the trial. We note that formal DVA enrolment records indicate no practice had more than 19 participants at any one time. As such, we have incorporated this response in the ‘unsure’ category.

Table G3: Maximum number of participants enrolled across the period of the trial per practice

Max number of trial participants enrolled across the

period of the trial

Interim Post-trial n=66 n=28

None 2 01 to 5 30 196 to 10 21 711 to 15 7 016 to 20 4 0Unsure 2 2

Two survey respondents (n=28) indicated in the post-participation survey that they were unsure how many participants were on the trial at their practice as they had taken over the position mid-way through the trial. The issue of staff turnover on the trial is discussed in the main report.

Responses to each of the questions asked of practices are provided below.


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When considering the overall health impact (quality, safety, outcomes) to your patients due to participating in the trial, please allocate the proportion (%) of your participants who experienced an improvement in their health outcomes

Respondents were asked to nominate the proportion of their participants who experienced an improvement in their health outcomes. The most common responses at the interim survey was that participants had experienced moderate improvement or no change. The most common response at the post trial survey was that participants experienced no change in their health outcomes. Practices considered that about half (45% at interim and 58% at post trial) of their participants experienced a significant improvement in their health outcomes due to the trial, a very positive outcome as summarised in Table G4.


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Table G4: Proportion of participants that experienced an improvement in their health outcomes

Response Interim survey Post-trial surveyAverage

% Min Max Std Dev Total (n) Average % Min Max Std

Dev Total (n)

Significant improvement 45.3 0 100 35.2 17 57.5 0 100 33.4 8

Moderate improvement 66.3 0 100 33.1 46 43.1 10 100 31.1 20

No change 65.5 10 100 30.9 27 67.9 10 100 26.6 20Moderate decline 10.7 0 30 11.8 7 6.7 0 20 9.4 3Significant decline 3.0 0 10 4.0 5 6.7 0 20 9.4 3

Overall, to what extent has the trial led to the following for one or more of your trial participants

Tabulations in Table G5 and Table G6 summarise the extent the trial led to a selection of outcomes for trial participants. The phrasing of the questions for this question differed slightly in the post-trial survey, so results have been summarised separately.


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Table G5: To what extent has the trial led to the following for one or more of your trial participants (interim practice survey)

Response

Significant decline

Moderate decline

No change

Moderate improvement

Significant improvement

Column %

Count

Column %

Count

Column % Count Column

% Count Column %

Count

Patients’ peace of mind (less stressed) 0.0% 0 40.0% 8 1.7% 4 10.4% 31 10.7% 16Partner/carer/family peace of mind 0.0% 0 5.0% 1 4.7% 11 8.4% 25 14.8% 22Stronger relationship b/w trial participant, carer, practice nurse and GP 0.0% 0 0.0% 0 3.0% 7 9.1% 27 16.8% 25

Enhanced information provision to trial participants’ specialist 0.0% 0 5.0% 1 13.6% 32 6.4% 19 4.7% 7Increased monitoring to stabilise trial participants’ health condition 0.0% 0 0.0% 0 5.9% 14 11.1% 33 8.1% 12

Medication titration or change 0.0% 0 0.0% 0 10.6% 25 8.7% 26 5.4% 8Enabled early intervention / prevented exacerbation of health condition 0.0% 0 5.0% 1 3.8% 9 10.4% 31 12.1% 18

Reduced trips to the practice 66.7% 2 15.0% 3 11.0% 26 7.0% 21 4.7% 7Avoided admission to hospital 33.3% 1 20.0% 4 11.4% 27 6.0% 18 6.0% 9Avoided transfer to residential aged care 0.0% 0 10.0% 2 14.8% 35 4.7% 14 4.7% 7Trial participant taking greater responsibility for own health 0.0% 0 0.0% 0 5.1% 12 11.1% 33 9.4% 14Potentially saved their life 0.0% 0 0.0% 0 14.4% 34 6.7% 20 2.7% 4


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Table G6: To what extent has the trial led to the following for one or more of your participating patients (Post-trial practice survey)

Response

Significant decline

Moderate decline No change Moderate

improvementSignificant

improvementColum

n % Count Column % Count Colum

n %Coun

tColum

n %Coun

tColum

n %Coun

tPatients’ peace of mind (less stressed) 0.0% 0 0.0% 0 4.5% 7 5.6% 8 14.9% 13Partner/carer/family peace of mind 0.0% 0 0.0% 0 4.5% 7 8.5% 12 10.3% 9Relationship between patient, carer, practice nurse and GP 0.0% 0 0.0% 0 2.5% 4 9.9% 14 11.5% 10

Information provision to patients' specialist 0.0% 0 0.0% 0 12.1% 19 4.2% 6 3.4% 3Monitoring to stabilise patients’ health condition 0.0% 0 0.0% 0 3.2% 5 10.6% 15 9.2% 8Medication titration or change 0.0% 0 0.0% 0 7.6% 12 7.7% 11 5.7% 5Early intervention / prevented exacerbation of health condition 0.0% 0 0.0% 0 8.3% 13 6.3% 9 6.9% 6

Identify new health concern 0.0% 0 0.0% 0 10.8% 17 5.6% 8 3.4% 3Time required at the practice 0.0% 0 66.7% 2 9.6% 15 4.9% 7 4.6% 4Admission to hospital 0.0% 0 0.0% 0 12.7% 20 3.5% 5 2.3% 2Admission to residential aged care 0.0% 0 33.3% 1 13.4% 21 1.4% 2 3.4% 3Patient understanding/ awareness of health/ condition 0.0% 0 0.0% 0 1.3% 2 13.4% 19 8.0% 7

Patient taking greater responsibility for own health 0.0% 0 0.0% 0 2.5% 4 12.0% 17 8.0% 7

Potential to save their life 0.0% 0 0.0% 0 7.0% 11 6.3% 9 8.0% 7


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A significant number of practices reported moderate to significant improvement (across interim and post surveys) as follows:

increased peace of mind (patient) increased peace of mind (partner/carer/family) increased relationship between patient/practice nurse/GP increased monitoring to stabilise trial participants’ health condition trial participant taking greater responsibility for own health enabled early intervention / prevented exacerbation of health condition patient understanding/ awareness of health/ condition potential to save their life medication or titration change.Many survey participants reported no change in a number of outcome categories summarised in Table G5 and G6. These include:

enhanced information provision to trial participants’ specialist identification of new health concern. Very few (8%) of respondents in both surveys felt that participants were visiting the GP clinic less. There were some discrepancies between respondents and other findings of the interim and post participation, and this may be based on the particular practice experiences.

Were there any other outcomes for trial participants?

Survey respondents were also asked about other outcomes not listed in the categories described in tables G5 and G6 and several themes were apparent.

Of the responses to this question to the interim practice survey (n=24), only six described no other outcomes for trial participants (compared with one in the post-trial survey, n=12) – with one stating that their patient has always had regular appointments so this trial had not impacted on his health outcomes. Five participants identified increased communication between health provider and patient as another resultant health outcome related to the trial. One respondent further explained the increased communication and relationship building was beneficial to the practice – that it did reduce the number of home visits required. One patient was identified as needing respite care because of the trial. One respondent also identified that their trial participant enjoyed the social aspect of being on the trial. Other broad positive themes include reassurance for patients, and peace of mind allowing them to have an increased quality of life. The most common positive feedback from the post-trial survey was that patients felt empowered (three responses, n=12). One respondent indicated the trial was very useful for INR monitoring resulting in that patient not having to travel a great distance to the practice.

General negative themes tended to surround increased stress for some patients, and some patients felt obligated to continue the trial based on pressure from family. Some patients struggled with the technology and this has led to increased frustration, but also that the service provider was supportive through these challenges. One survey participant reported that one patient no longer answers the phone as she was fed up with phone calls from the service provider nurses telling her that she was sick.

Answers to this question in the interim survey were equally weighted to positive and negative experiences, whereas most responses in the post-trial surveys were positive. There were only three negative outcomes reported in the post-trial survey regarding increased stress levels associated with false readings that needed to be acted upon which led to increased stress at the clinic and for the patient and other issues with the


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technology (such as frequent battery replacements required) that added to increased stress levels. These issues have also been noted in the participant survey analysis.

How would you rate the impact of using the telemonitoring equipment on your efficiency (time or direct cost) in delivering health care services to your trial participants?

Practices were also asked to rate the impact of using the telemonitoring equipment on their efficiency (time or direct cost) in delivering health care services to trial participants. Results from the interim practice survey are tabulated below:

Table G7: Rating the impact of using the telemonitoring equipment on respondent efficiency (time or direct cost) in delivering health care services to

trial participants (n=59)

Significant decline

Moderate decline No change Moderate

improvementSignificant

improvement

1 13 13 27 52% 22% 21% 47% 9%

Most practices considered the impact of using the telemonitoring equipment on their efficiency in delivering health care services to have a moderate improvement (47%, n=58) at the interim survey. Only one respondent considered the telemonitoring equipment to have a negative impact on their ability to deliver health care services to trial participants. At interim, survey respondents were asked to rate what that efficiency related to. This is illustrated in Figure G1.

Figure G1: Rating as a percentage, attributed to improvement of efficiency (n=64)

Practices that identified an improvement in their efficiency mostly related this to the availability of vital signs data (28 ratings attributing 73.7% agreement, n=64). This was followed closely by the ability to deal with issues as they were identified over telephone or videoconferencing (27 ratings attributing 71.1% agreement). Respondents were then asked an open-ended question to further explain any other efficiencies. Fourteen responses were gathered in response to this question with most explaining how they were more efficient (seeing the results directly or by the service provider communications). One respondent indicated that one patient was recording higher blood pressure when using telemonitoring equipment than in the surgery and another respondent mentioned that all this extra data takes extra time to evaluate. Other Appendices to Final reportAugust 2017

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comments affirm a better relationship with patient when in practice. One respondent also mentioned that due to the availability of this data, one patient could be diagnosed with a serious condition earlier and treatment commencing earlier than would have been possible without the trial. The question style was modified slightly in the post-trial practice survey which makes direct comparison difficult, with respondents asked to rate the impact of using telemonitoring equipment on practice efficiency (significant decline to significant improvement) relating to four specific areas, summarised below:

Table G8: Rating the impact of using the telemonitoring equipment on practice efficiency (relating to four areas) - post-trial practice survey

Response

% of countSignificant

declineModerate decline

No change Moderate improveme

nt

Significant improveme

ntAvailability of vital signs data 0.0% 0.0% 13.0% 33.3% 38.5%Number of 'tests' or 'diagnostics' needed 0.0% 0.0% 37.0% 17.6% 7.7%

Ability to deal with issues as they are identified over phone or videoconferencing

0.0% 0.0% 13.0% 33.3% 38.5%

Ability to see patients in practice (not coming to practice for review)

0.0% 0.0% 37.0% 15.7% 15.4%

Total count 0 0 46 51 13Average 0.0% 0.0% 41.8% 46.4% 11.8%

As per the interim survey, the largest proportion of post-trial respondents indicated that significant improvements to efficiency related to the availability of vital signs data, and the ability to deal with issues in a timely way over the phone or videoconferencing. No change was reported for the number of tests or diagnostics needing to be undertaken or organised or the ability to see patients in practice as patients on trial were not coming to practice for reviews.

Respondents were also asked to explain any further efficiencies they could identify in an open-ended question. Eight responses had similar responses to the interim practice survey, with the addition of less visits for INR testing being mentioned by one respondent. Inefficiencies or no change were described due to technology difficulties or convenience of local patients who had a preference of seeing practice staff face to face anyway.

From your observations, to what extent has the trial affected carers of trial participants?

Respondents were also asked to suggest to what extent the trial affected carers of trial participants. Results can be seen in Table G9. Respondents could select more than one response in the interim practice survey and the post-trial survey.


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Table G9: Extent the trial affected carers of trial participants

From your observations, to what extent has the trial affected carers of trial participants?

Tick all that apply

Interim survey

Post-trial survey

n=119 % of n n=55 % of

nIt has lessened the burden on carers overall 19 16% 9 16%Carers have more confidence in assisting the trial participant 23 19% 10 18%It has given carers more peace of mind 35 29% 18 33%It has increased the stress and pressure on carers 11 9% 2 4%Carers have had more to do to assist trial participants use the trial equipment 17 14% 6 11%It has made no difference to carers 5 4% 6 11%Not applicable 9 8% 4 7%

Results were proportionally similar between the interim and post-trial surveys for this question. Most survey respondents indicated that they thought that the trial has given carers increased peace of mind (29%, n=118 and 18%, n=55 for post-trial survey). Nine respondents did not feel the question was relevant initially (versus six in the post-trial survey) and five indicated that it has not affected carers at all initially (versus four in the post-trial survey). Giving carers increased peace of mind has been consistent using several data collection methods, including the case studies. The survey also found that a moderate number of respondents indicate the trial has reduced the burden on carers overall, and has increased their confidence in assisting their patient/family member. These are positive outcomes, and importantly, no negative impacts have been reported for carers.

G.2 CHARACTERISTICS OF TRIAL PARTICIPANTS THAT HAVE BENEFITTED THE MOST

The next part of the survey explored characteristics of the trial participants that benefitted the most from the trial. The questions were modified slightly and comparisons between the interim and post-trial practice survey have been made where possible.

Age of trial participants

Most respondents (for both surveys) indicated that the trial was of the most benefit to those between 80 and 90. Very few felt the trial benefited the youngest age group, but this may reflect the age group of their local participants. Results are tabulated below.

Table G10: Age group trial has benefitted the most

Age of trial participant that have benefited the most

(years)

Interim survey Post-trial survey

n=63 % of n n=30 % of n50-60 0 0% 2 7%60-70 13 21% 6 20%70-80 17 27% 6 20%80-90 27 43% 14 47%90+ 6 10% 2 7%

Respondents were then asked to explain their response. No extra information was provided for the interim survey, however sixteen respondents offered rationale for their selection in the post-trial survey. Note that responses were limited to small practice


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samples and their own experiences only. A sample of themes (in no priority order) in response to this question included: personal contact was beneficial for those that stayed on the trial, and was not

dependent on age being comfortable with technology was more of a factor than age telemonitoring was used differently for different age cohorts i.e. younger trial

participants were diagnosed earlier (focus on early detection) and older trial participants were symptom controlled

difficulty with the equipment was cited as being more of an issue with the older age brackets.

Health conditions with other co-morbidities

Health conditions with other co-morbidities was the next category explored. Most respondents indicated that the trial was the most beneficial to trial participants with congestive heart failure (CHF) (30%, n=32) in the interim survey, but chronic obstructive pulmonary disease (COPD) was considered the condition that benefited the most from the post-trial survey (25%, n=48). See results below:

Table G11: Health conditions with co-morbidities the trial has benefitted the most

Health conditions of the patient that have benefitted the most from the

trial


n=107 % of n n=48 % of nCHF 32 30% 12 25%COPD 29 27% 13 27%CAD 15 14% 9 19%Diabetes 28 26% 10 21%Co-morbid* - - 2 4%Other 3 3% 2 4%

*The question was phrased slightly differently in the post-trial survey – where co-morbidities were listed separately. The two co-morbid conditions that were indicated were atrial fibrillation (AF) and anticoagulant management.

Respondents were asked to expand on their selection. No survey participants expanded on their selection at interim, but six offered rationales in the post-trial survey. A summary of this feedback is included below: it was valuable to get a snapshot of their health at home monitoring enabled early intervention of all health conditions on the trial an infrequent practice attendee needed medication changed because of her

monitored readings early intervention enabled a patient to be sent for hospital with cellulitis and

bradycardia because of monitoring advantages to providing help to patients in the palliative state in the comfort of their

own home.

Distance from the practice or other difficulty accessing

Distances form the practice was the next theme explored. Most respondents in both surveys indicated that trial participants that were less than 10 km from the practice benefitted the most from the trial (64% of responses, n=59 and 38% of responses in the post-trial survey). Only two respondents indicated that participants located greater than


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60km away would benefit the most (and this was similar in the post-trial survey, where one respondent agreed). Results are summarised in below.

Table G12: Trial participants that have benefitted from the trial, distance from the practice or other difficulties accessing the trial

Distance from practiceInterim survey Post-trial survey

n=59 % of n n=21 % of nLess than 10 km away 38 64% 8 38%10 - 20 km 10 17% 7 33%20 - 40 km 8 14% 5 24%40 - 60 km 1 2% - -Greater than 60 km away 2 3% 1 5%

No respondents expanded on their selection for this question for the interim practice survey, however 12 responses were provided in the post-trial survey. General themes included: patients were all local to the practice anyway (two responses) closer older patients were more likely to want to see a doctor face-to-face one respondent indicated all patients benefited and others (three responses)

indicated distance was not relevant.

Family or carer support

Respondents were asked to select whether trial participants benefitted from in-home family or carer support or outside-of-home family or carer support. At interim, 51% (n=45) of respondents indicated that trial participants benefitted more from in-home family or carer support. This was similar in the post-trial survey (61.5%, n=13). No respondents expanded on this choice at interim. Eight responses were left in the post-trial survey – summarised below: increased patient peace of mind for participant and family/carers (most responses) allowed participants to continue to live independently (three responses) and suited

personality types that did not like waiting around for home-visits.

G.3 TRIAL PARTICIPANT TEMPERAMENT, COGNITIVE ABILITY OR PERSONALITY TYPE

Thirty-seven responses were recorded against the question asking respondents to describe the most beneficial trial participant temperament, cognitive ability or personality type in the interim survey, eighteen responses were submitted in the post-trial survey. Most responses indicated that trial participants that were cognitive, active, friendly and open to the technology performed better with the technology and hence got more out of the trial – this was similar in the post-trial survey results. There was some concern regarding those with cognitive impairment and dementia not being suitable. Several responses indicated that frustration levels could be a problem, and that anxious and depressed patients did not fare as well with the equipment. A few responses also indicated that the older patients were not as adept with the equipment.

Prior familiarity with technology

Prior familiarity with technology was the next question exploring types of trial participants that would benefit the most from telemonitoring. The question was phrased slightly differently in the post-trial survey (to enable respondents to select yes or no). There was very little difference determined by respondents to this question in the post-trial survey


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with 11 respondents (52.4%) indicating prior familiarity with technology benefitted trial participants more on the trial (versus ten respondents that disagreed). Most interim free-text responses indicated that most of their patients had very little prior experience with technology with most responses indicated as ‘none’ or ‘minimal’ (47% of 38 responses). Technology failure was indicated by one respondent as their ‘biggest obstacle’. Several respondents indicated that trial participation was easier for those with more technology experience. Similar views were expressed in the free-text part of this question in the post-trial survey. However, one respondent indicated that three quarters of participants at their practice became technology literate because of the exercise and this was supported by at least two other respondents. One respondent indicated that their oldest patient arguably had the best information technology skills, but he was frustrated by the difficulties associated with achieving adequate internet access and getting everything operational.

Trial participant prior involvement with Coordinated Veterans’ Care (CVC)

The final question in this series of questions asked respondents to indicate whether it was beneficial that trial participants had prior involvement with CVC. This was another open-ended question in the interim survey but closed for the post-trial survey – which contained a subsequent question asking respondents to explain their answer. Of the 37 respondents in the interim survey, 24% indicated that their patients were not CVC patients prior to the trial. The rest indicated that they were or most of the participants were prior CVC patients. Most respondents in the post-trial survey indicated that they thought prior involvement with CVC benefitted participating patients more while on the trial (57%, n=21). Only two responses to the interim survey indicated that being a prior CVC patient might offer some advantages in making the trial easier, in that they were more accepting of the trial. Eleven explanations were offered in the post-trial survey. General themes included: prior CVC patients had established rapport with the nurse prior to the trial so the

transition was easier (five responses) those that were previous CVC patients already had a concept of preventative health at least three responses did not believe CVC made a difference.

G.4 CHARACTERISTICS OF TRIAL PARTICIPANTS THAT HAVE BENEFITTED THE LEAST

The same questions phrased to focus on trial participants that have benefited the least were then asked. There was less clarity and more confusion in analysing these responses – possibly due to the similar wording of the questions and respondents not appreciating the value add of explicitly describing the shortcomings of the trial design on outcomes.

Age of trial participants

Table G13 summarises the responses acquired regarding the age bracket of trial participants that benefitted the least from the trial. Most respondents (44%, n=36) agreed that the bracket of 80-90-year-old trial participants benefited the least from the current trial model in the interim survey. However, most respondents in the post-trial survey indicated that patients that were over 90 years old benefitted the least in the post-trial survey (39%, n=18), but this was very closely followed by 58.8% (n=18) of respondents agreeing that the 80–90 year-old age bracket benefitted the least. No further explanations were offered to the following question asking respondents to expand on their selection for the interim survey, however fourteen responses were left in the post-trial survey. Most responses indicated this age bracket was the least comfortable with technology. Many comments were left that this was a challenging question to answer as they did not have a large enough sample to comment on so could only make assumptions based on the age of the patients they had on the trial. It is also noted that respondents indicated that the 80-90 year age group benefitted the most, again Appendices to Final reportAugust 2017

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indicating survey analysis of this question is highly dependent on the practice’s unique experience.

Table G13: Age of trial participants that have benefitted least from the trial

Age of trial participants that

have benefitted the least


n=36 % of n n=18 % of n

50 – 60 Years 4 11% 1 6%60 – 70 Years 7 19% 1 6%70 – 80 Years 9 25% 1 6%80 – 90 Years 16 44% 7 39%90 + Years 0 0 8 44%

Health conditions with other co-morbidities

Respondents were also asked to allocate health conditions and comorbidities of trial participants that have benefitted the least from the trial. Both congestive heart failure (CHF) and diabetic patients scored 28% each (n=50), making these conditions the least benefitted health conditions. This is a contrast to the result when compared with the similar question asking what health conditions benefitted most from the trial as 30% of respondents, (n=107) selected CHF as the condition that benefited most from the trial at interim. A similar effect resulted in the post-trial survey where 29 percent (n=14) of respondents indicated that COPD was the condition that benefitted the least from the trial (when this condition was considered to have benefitted the most from the same cohort of respondents in the similarly phrased question asking respondents which condition benefitted the most from the trial. Thus, these results should be interpreted with caution, as the phrasing of the question may have caused confusion. In addition, responses reflect the diverse experiences of different practices and their cohort of participants. Results are summarised in Table G14, below.

Table G14: Health conditions and comorbidities of participants that have benefitted least

Health conditions and comorbidities of trial participants that have benefitted

the least


n=50 % of n n=14 % of n

CHF 14 28% 2 14%COPD 7 14% 4 29%CAD 13 26% 1 7%Diabetes 14 28% 1 7%Co-morbid* - - 3 21%Other 2 4% 3 21%

*The question was phrased slightly differently in the post-trial survey – where co-morbidities were listed separately. The three co-morbid conditions that were indicated were hearing and vision impairment, post-traumatic stress disorder (PTSD) and dementia.

No answers were left to explain the results at interim. Ten responses were submitted for the post-trial survey with half of all responses submitted for this question indicating they had benefited or the question was not applicable.

Other responses included:


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“too many cooks’ and too much focus on little things increased anxiety and reduced health and wellbeing – he has been much better since we took him off the trial”

age was more an issue than the condition as some trial participants felt they were taking the opportunity from another veteran if they were stable, and some of the older patients thought they were too old to be bothered with

those with dementia or cognitive impairment did not perform the readings satisfactorily

hearing impairment impacted the ability to remote troubleshoot as the patient could not hear the IT instructions.

Distance from the practice or other difficulty accessing

Respondents were also asked to determine what distance from the practice benefitted trial participants the least. Responses are summarised in Table G15. Seventy-nine percent (n=26) of respondents indicated that those trial participants that lived less than 10km away from the practice, benefitted the least from the trial at interim. This was supported by results from the post-participation survey (47%, n = 17). This response also contradicts the results from the similarly worded question summarised by Table G12 that indicated that trial participants that lived less than 10km away benefitted the most from the trial from both surveys. No further explanation was recorded to explain these results at interim. Twelve responses were submitted in the post-trial survey but most of the responses indicated confusion or that distance was not an issue or that the practice was locally based and most patients lived locally. Again, these contrasting results indicate unique practice experiences with their participant cohorts.

Table G15: Distance from practice for trial participants that have benefitted least from the trial

Distance from practice that benefits

trial participants the least


n=33 % of n n=17 % of nLess than 10km away 26 79% 8 47%10 - 20 km 4 12% 5 29%20 - 40 km 2 6% 2 12%40 - 60 km 1 3% - -Greater than 60km away 0 0% 2 12%

Family or carer support

Whether family or carer support came from in-home or outside-of-home, benefitted trial participants the least was also asked of the practices. Seventy percent of respondents (n=27) indicated at the interim survey that in-home family or carer support benefitted trial participants the least, and this was supported by the post-trial survey response to this question (61.5%, n=13). Both of these responses also contradicted the question asking whether trial participants benefitted most from in-home or outside of home family or carer support where 51% (n=45) indicated that in-home patients benefitted the most initially, as well as in the post-trial survey (61.5%, n=13). It is noted that this question may have caused confusion for respondents, and interpretations of results should be read with caution.

Seventeen responses were entered to explain the response to the previous question at interim. Five practice responses indicated their trial participant lived with their spouse or son, and others indicated their participants lived independently without a carer so the trial did not impact them with regard to carer support. Other themes included:


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family (including grandchildren) assisted with readings ceasing trial due to equipment failure and stress associated with monitoring.Seven responses were provided in the post-trial survey, associated themes included:

both in home and out of home care is beneficial (one response) can only comment on specific patients technical issues increased confidence to live independently at home (two responses) gives patients options, especially those “not willing or wanting people at the house”.

Trial participant temperament, cognitive ability or personality type

Respondents were also asked to detail the patient temperament, cognitive ability or personality type that benefitted the least from the trial. Thirty-one responses were left to this question initially. Most responses indicated that anxious patients benefitted the least from the trial. Other themes included: competent patients alert patients active and independent social participants with active social lives, that resented the intrusion and phone calls

from the service provider.Many responses presumably described the temperament of their trial participants, regardless of whether they were a good fit to the question (benefitted the least from the trial) and described why their participant left the trial. Sixteen responses were left with similar themes to the interim survey in the post-trial survey in that anxious or those that were impatient benefitted the least from the trial with the additional comments of those with a busy personal life, new partner or those that were deaf – that differed from interim responses.

Prior familiarity with technology

Whether prior familiarity with technology benefitted trial participants the least was discussed. Twenty-eight responses were initially gathered. Most responses described their individual patient experiences with technology and were brief with 11 of the 28 responses indicating no real prior familiarity with technology. Other responses indicated that trial participants had a basic familiarity with technology. Five responses indicated their trial participants had a good prior familiarity with technology at interim. It is not clear from the responses gathered whether the lack of familiarity with technology benefitted trial participants the least or responses were describing whether the trial participants had a prior familiarity with technology. The question was altered for the post-trial survey and asked, ‘has prior familiarity with technology made the trial easier for patients?’ Seventeen responses were submitted in response. Four responses said no, six responses indicated yes, three responses indicated not applicable or probably. Those that extrapolated described experiences of their trial participants in that if patients were more familiar with technology initially they found the tablets easier to operate and had greater confidence in monitoring. One response highlighted that an anxious patient became less anxious through learning how to use the technology over time.

Trial prior involvement with Coordinated Veterans’ Care

Trial participants’ prior involvement with CVC deriving least benefit was also asked at interim and the question was rephrased in the post-trial survey to ‘Have participating patients who were involved with CVC prior to the trial benefited less than other participants?’ Of the responses gathered at interim (n=21), most responses indicated Appendices to Final reportAugust 2017

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whether patients had prior involvement with CVC, and not if this influenced the benefit of trial participants to the negative. One respondent seemed confused as “all current participants were on our CVC program prior to starting the trial (as this was prerequisite)”. In response to the rephrased question – 16 responses were submitted and all indicated that CVC made no difference to trial participants or was not applicable.

Have you noticed that there are certain chronic conditions that the trial works best for?

Most respondents (33%, n=87) indicated that CHF was the best chronic condition to be managed by the trial. Results are tabulated below. Two respondents indicated that other chronic conditions could also be managed by the trial – suggesting that it could also work for mental health issues. This question was removed in the post-trial survey as it was perceived as repetitive.

Table G16: Chronic conditions that the trial works best for

Are there certain chronic conditions that the trial works

best for and why?(tick all that apply)

n=87 % of n

CHF 29 33%COPD 17 20%CAD 13 15%Diabetes 23 26%Other* (please detail) 2 2%None 3 3%

Twenty responses were recorded from respondents to further explain their selection to the previous question. Those that selected CHF, indicated advantages with weight monitoring. Those that selected COPD cited advantages to monitoring vital signs such as oxygen saturation. Monitoring blood glucose levels for diabetic patients was also useful. Several comments indicated problems with the pulse oximeter, and one respondent indicated their patient “was asked not to perform lung function tests as it distressed her too much…” Other comments included: gives patients a feeling of control in their health participants were more likely to respond to their symptoms and seek an appointment.

Are there certain chronic conditions that the trial does not seem to work well for and why?

Conversely, respondents were also asked to select what conditions the trial did not seem to work well for. Most respondents indicated that the trial works for all of the selected chronic conditions with 61% of respondents (n=31) indicating ‘none’. This question was also removed from the post-trial survey as it was perceived as repetitive. Interim results are tabulated below.


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Table G17: Chronic conditions that the trial does not seem to work well for

Are there certain chronic conditions the trial does not seem to work well

for and why?n=31 % of n

CHF 1 3%COPD 3 10%CAD 4 13%Diabetes 3 10%Other* (please detail) 1 3%None 19 61%

Eleven survey participants responded in explanation of their selection to the above question. Prominent themes include: objective monitoring more difficult problems with the equipment (e.g. Pulse Oximeters) – three further responses inaccuracy of readings – two responses some concern that coronary artery disease (CAD) monitoring is not useful when

angina presents.

G.5 SERVICE UTILISATIONService utilisation with other health services was also surveyed.

What is the level of interaction with other services the trial participant receives?

Respondents were asked to rank trial participants’ level of interaction with other services initially and in the post-trial survey. Most interim and post-trial responses indicated ‘no change’ in service utilisation (59%, n=49 and 66.7%, n=24). Results are summarised below.

Table G18: Level of impact on delivery of other services

Significant enhancement

Moderate enhancement No change Moderate

detractionSignificant detraction

Interim

n=49

Post-trial n=24

Interimn=49

Post-trial n=24

Interim

n=49

Post-trial n=24

Interim

n=49

Post-trial n=24

Interim

n=49

Post-trial n=24

4 2 16 6 29 16 0 0 0 08% 8.3% 33% 25% 59% 66.7% 0% 0% 0% 0%

Twenty-eight responses were initially left in explanation to the previous question about service utilisation. Most comments indicated there was no change with other services, due to no need by individual patients (5 responses). Other themes included: low reliance on telemonitoring data from the service provider when referring client for

ongoing care no difference, except extra emails, calls and triage page checking some increase in support services because of participation more data to provide specialist or emergency services practice has been alerted to any problems/needs the client may have.


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Ten responses were left in the post-trial survey which asked what services have been affected, with similar themes to the interim survey, except for:

DVA clients tend to be more connected to the clinic and their specialists regardless of their participation in the trial (two responses).

Specific services identified as being improved included:

community nurses had more information available to them RSL Lifecare Nurses (no other explanation provided by respondent) DVA taxi (no other explanation provided by respondent).Three specific responses indicated there was no change in service delivery except for increased calls from the service provider.

Has the trial enhanced or changed your role as a practice nurse, practice manager or GP?

Survey respondents were asked whether the trial enhanced or changed their professional role (practice nurse, practice manager or GP). Fifty six percent of respondents indicated that it had changed or enhanced their role at interim (n=50), and 58.3% of respondents agreed in the post-trial survey (n=24). The following major themes were apparent in the post-trial survey responses (n=15): increased level of analysis learned i.e. increased skill-set greater level of empathy for veterans increased information available to plan services/care an overabundance of data produced which was time consuming increased communication and relationship building between patient and practice.

Have you used video conferencing at all? If not, why not?

Videoconferencing was a tool available to participants and practices on the trial. Respondents were asked if they used videoconferencing with trial participants. They were asked to explain their response if they had not used the tool. Forty-six responses were submitted to this open-ended question at interim and 23 responses were provided in the post-trial survey. Most respondents indicated that they did not use videoconferencing at interim and none of the respondents in the post-trial survey indicated they used it. Only seven responses indicated that they used videoconferencing at interim, and half of these were not successful. Further explanations across interim and post-trial surveys included: normal telephone contact was sufficient it was used by the service provider staff technical issues preference by trial participants for face-to-face no facilities to use in practice (two responses at interim).

G.6 TRIAL DESIGNPerspectives on the trial design were also surveyed across practices.


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Does the current trial model provide the most effective mechanism to maximise the benefits of telemonitoring to trial participants and practices?

Respondents were asked if the current general practice-centred trial model provided the most effective mechanism to maximise benefits of telemonitoring to trial participants. Most respondents at interim and in the post-trial survey indicated that the current trial design was the most effective mechanism (89%, n=37 and 83.3%, n=18). Survey participants were then asked to explain their response. Twelve comments were recorded at interim and 16 responses in the post-trial survey. Major themes included:

GP had the most holistic viewpoint of the patient – two comments (interim) hard to compare as no other method was trialled – two comments (interim) increasing number of clients may be problematic probably great in remote areas a place for a telemonitoring nurse to liaise with practice nurse and participant a suggestion for a home visit once a month by a nurse may be more effective.Several comments in the post-trial survey indicated they could not answer the question fully as they were not aware of what other models were available (five responses).

Relevance of a selection of factors to the uptake or success of telemonitoring by your practice

A series of factors relevant to the success or uptake of telemonitoring by the practice were asked of respondents. Respondents could select more than one response. Results are summarised below. Most respondents at interim selected a Dedicated Coordinated Veterans’ Care nurse as critical to the success of telemonitoring by their practice (17%, n=179). GP engagement and/or advocacy and number of trial participants ranked equal second (14%, n=179 each), followed closely by prior adoption of CVC and number of nurses in practice (13%, n=179 each). In the post-trial survey – the most highly rated selection was equal for the number of trial participants and prior adoption of CVC (18%, n=85). Results from both surveys can be seen in Table G19 and Figure G1. Two responses were left in explanation at interim: one indicating “patients have described good relationships with Tunstall staff, aware of staff names, and will relate conversations had with Tunstall staff”, and another comment suggested uptake was very low probably due to the age of patients as:

“[all] were WW2… [Younger] clients would benefit and understand a lot more than the 80 + clients, and have the added benefit of technology experience. Maybe dedicated CVC nurse could enhance success [at the respondents’] practice. CVC clients [were] spread amongst 3 nurses to attend amongst … other responsibilities at the practice. GPs on the whole were not greatly involved in monitoring; [nurses] liaised with them if results required follow up only. On all occasions that [the respondent could recall, a] GP would then want to see client at consult. Not great enthusiasm from GPs.”

One response was left to explain ‘other’ in the post-trial survey, suggesting the ability of the practice nurse to relate to the patient was important – particularly regarding veterans. This relationship is discussed further in the main report.


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Table G19: Factors determining uptake or success of telemonitoring

Factors relevant to uptake or successInterim survey Post-trial survey

n=179 % of n n=85 % of nSize of the practice 17 9% 6 7%

No. veterans participating 25 14% 15 18%Prior adoption of Coordinated Veterans' Care 24 13% 15 18%No. nurses in practice 24 13% 11 13%

Dedicated Coordinated Veterans' Care nurse 30 17% 10 12%

GP engagement and/or advocate 25 14% 10 12%

Trial participant distance from practice (rurality)

10 6%11 13%

Practice's uptake of other technology 22 12% 6 7%

Other* 2 1% 1 1%

Figure G1: Factors determining uptake or success of telemonitoring by each practice

Overall, what has worked well and not worked well in relation to the trial?

This question was presented differently in the interim and post-trial surveys and hence analysed separately. Respondents were asked to select what had worked well and what had not worked well in a single question in the post-trial survey and the questions were separated and open-ended in the interim survey.

Respondents were given the opportunity to describe what they thought worked well overall in relation to the trial at interim in an open-ended question. Thirty-five responses were left. The following themes were identified:

improved patient outcomes because of prompt treatment


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monitoring equipment largely worked well – and technical difficulties were promptly dealt with by the service provider

ability to remotely monitor vital signs increased communication between patient and practice staff increased relationship between patient and practice staff teamwork with the service provider nurses was considered an advantage increased autonomy and peace of mind for the patient.The most common response nominated by post-trial survey respondents was that communication with the service provider worked well (12.5%, n = 176), followed closely by the GP practice centred model and software used.

Survey respondents were also asked at interim to nominate factors that did not work so well in relation to the trial. Patient selection was rated as the factor that worked the least well at interim (29%, n=65) with technology used a close second (25%, n=65). Hardware was considered the factor that worked the least well in the post-trial survey (23%, n=39). Results are summarised below integrating the post-trial survey differences and extra data collected where possible:

Table G20: Factors working well and not working well in relation to the trial (all that apply)

Factors working or not working well

Interim survey

Post-trial survey

Interim survey

Post-trial survey

Not working well Working welln = 66 n=39 n/a n=176

Patient selection 19 4 - 18Technology used (tablet, ICP triage manager, internet connection) 17 -

--

Hardware used by patient (tablet, peripherals) - 9

-15

Software used (ICP triage manager) - 2 - 20Internet connection - 5 - 18General practice-centred model 1 2 - 20Payment / compensation for services 6 4 - 16Service provider (Tunstall) 0 1 - 21Communication with service provider (Tunstall) 5 1

-22

Communication with DVA 6 3 - 17Interaction with other health services 4 7 - 9Other* 8 1 - 0

Respondents were also asked to explain their selection to the previous question. Thirty-one responses were recorded initially in response to what was not working well, with one response left in the post-trial survey regarding difficulties with the pulse oximeter.Despite communication being considered one of the benefits from the trial as indicated in Table G20, communication was also considered the most common theme in response to factors not working well (five responses). Other broad themes were spread relatively evenly and included:


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patient selection – age (pre-WW2), technology savvy and interested patients should be included to improve retention

results should be integrated into medical record software payment schedule needs to be simplified no dedicated time for the program patient technology issues or unwillingness to use the technology.

Isolated comments included that it was disappointing “private DVA nurses” were not included in the Trial to increase coordination and cooperation around the participant’s care plan (it is noted that DVA-funded community nurses and CVC nurses are not employed directly by DVA.) There were also affirmations that the service provider had been ‘amazing and supportive to any questions/concerns’ had by the respondent.

As the question was formatted differently in the post-trial survey – respondents were asked to explain their response to the combined question (what worked well and what was not working well). A number of positive and negative comments were submitted. General themes from twelve responses included:

morning tea to engage participants about the trial initially was supported (two comments)

lack of GP engagement with the program was disappointing technology difficulties (including internet connection) contributed to patient drop out

and frustration (four comments) communication with and from the service provider was generally highly regarded

(three comments).

What are the key opportunities for improvement?

Key opportunities for improvement was also asked in the interim and post-trial survey. This was another open-ended question. Twenty-eight responses were submitted initially and 15 responses were left in the post-trial survey. Many responses referred to their response to the previous question (factors that are not working well in relation to the trial). Different themes, not already mentioned in response to the previous question included:

increased notice to allow practices to recruit more suitable patients tougher criteria for patient selection quality of equipment needs to improve extended patient conditions (PTSD, severe depression and arthritis) reduced frequency of monitoring and adjust as health permits.

One respondent in the post-trial survey indicated greater education for practice around Veteran entitlements would have been helpful and one other respondent indicated that a key contact person (within the office of the service provider), e.g. for provision of advice would have been an improvement. The other responses were very similar in sentiment to the interim survey.

Do you see a potential for this model to work in other health applications, conditions or populations?

Survey participants were also asked if this model could work in other applications, conditions or populations. Approximately 91 percent of respondents indicated positively in both surveys (n=46 and 23).


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Further expansion on this question resulted in a further 39 responses initially and 17 responses in the post-trial survey. Most responses indicated that Indigenous and rural/remote settings would benefit from application of this model (nearly half of all interim survey responses) and this was supported by a similar proportion in the post-trial survey. Specific conditions that it could be useful to include (as described) include: any chronic disease diabetes management PTSD, depression/anxiety and other mental illnesses.

Other population groups suggested included: pensioners (not veterans) anyone socially isolated parents could monitor sick children and upload results home dialysis patients anyone that did not drive.

G.7 OVERALL ASSESSMENTThe final section in the survey asked respondents their broad views on telemonitoring.

What is your overall assessment of telemonitoring?

Respondents were asked to allocate a proportion of their agreement with each statement regarding their overall assessment of telemonitoring. Statements and results are tabulated below. Most interim respondents (38%, n=91) indicated that they agreed on average 67.6% with the statement that it has provided an invaluable tool to assist in the care of trial participants whereas most post-trial respondents (46.5%, n = 43) agreed on an average agreement percentage of 66.3 % (n = 20) that telemonitoring was a nice tool to have but it has made little difference to trial participant health outcomes and/or the way the practice operates. Results are summarised in Table G21.

Table G21: Agreement with each statement regarding respondent’s overall assessment of telemonitoring

Factor of assessment of telemonitoring


nAverage agreeme

nt (%)n

Average agreeme

nt (%)Invaluable tool 35 67.6% 14 47.5%Nice tool to have but it has made little difference to trial participant health outcomes and/or the way the practice operates.

34 54.8% 20 66.3%

Has impacted negatively on my trial participants and/or the way the practice operates 22 11.5% 9 12.2%

Respondents were also asked to explain their response to the previous question. Thirty-two responses were recorded at interim, and 11 responses were submitted in the post-trial survey with very similar themes. Most responses at interim indicated difficulty in answering this question with such small trial participant numbers or explained their mixed response as why patients did not benefit so much from the trial, others enjoyed it, and others resented it. Most other responses were like responses gathered for other questions (improved communication, supported independence of patients, practice nurses are time poor and GPs needed to be more engaged). Other themes included:


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too much data being sent for the patient minimal changes in practice operations trial has been beneficial in identifying instability/acute events in diabetic and cardiac

patients increased support from other nurses would have been appreciated.

Other comments included concern that one patient’s mental health was affected by the trial and that patient selection was important to support improved outcomes. One post-trial respondent indicated the most benefit was the INR monitoring and patient personality made a huge difference to patient compliance therefore patient selection for appropriateness is important.

What additional and/or unexpected benefits does the telemonitoring trial bring to your trial participants?

What additional and/or unexpected benefits does the telemonitoring trial bring to trial participants was also asked as an open-ended question for interim survey participants but the question was removed for the post-trial survey. Twenty-four responses were submitted initially. General themes included: increased patient’s confidence to call practice increased confidence in patient’s ability to use technology increased accessibility to practice without increased travel feeling like a valued member of society reassurance for the anxious patient.

Potential for telemonitoring to be a standard part of care for all patients with chronic conditions, particularly those with access or mobility issues

The potential for telemonitoring to be a standard part of care for all chronic disease patients was asked in the interim and post-participation survey. Eighty-four percent of respondents indicated yes to this question at interim (n=43) and this response was very similar for post-trial respondents (86.7%, n=21). Respondents were then asked to detail what health conditions or populations they would expect this model could work for. Thirty responses were recorded at interim. Most of the responses (73%, n=30) referred to previous answers (any chronic disease, Ischaemic Heart Disease, COPD, COAD, diabetes, rural/remote). A sample of responses that differed included:

mobility restricted patients younger patients with computer knowledge atrial fibrillation would benefit from in-home monitors hypertension agoraphobics, labile diabetics, ‘long term illness’ patients anyone living in their own home with carers who cannot attend practice easily.

There was general agreement that telemonitoring was useful for most chronic conditions in the post-trial survey. The following positive themes were identified. Feasible alternative for those that are house-bound Reinforcement that it was ideal for rural or remote clients There was preference to be used in the early detection of at risk clients particularly

for diabetes.


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There was limited negative feedback except for one response that indicated that there were too many players (i.e. the service provider as the third party) and it was too complicated.

Are any of your trial participants using the eHealth record?

Final questions focused on patients using the eHealth record. Respondents were asked if their patients were using the eHealth record. Most at interim indicated that they were not (82%, n=45), however, most indicated that they were by the post-trial survey (57.1 percent, n=21) – although this may reflect the small sample size. Twenty-eight free-text responses were initially recorded, explaining the previous selection of eHealth record adoption. Common themes included:

unsure of the benefit - 3 responses general disappointment with integration of eHealth with current practice software data would be useful for hospital admissions if data could be easily uploaded – 5

responses might be too much information maybe in the future (when the technology is better) as not many are using it now better communication between all health practitioners.

Specific comments included: “eHealth has limiting coding for diagnostics and GPs do not feel it is accurate enough” and it is more “appropriate for monitoring to be integrated into the practices clinical information system, not PCEHR which is not intended for communication with the usual GP.” The free text option was removed from the post-trial survey for this question.Respondents were asked in the post-trial survey if they could see the e-Health record being integrated with telemonitoring to which most responses indicated affirmation (90.5%, n=21). Thirteen responses were submitted in explanation of their selection, including: personal GP views limit this potential (two responses) it would enable greater coordinated care, however, most clients only visit the one GP

for this cohort (two responses).

Are there any other issues that you have come across or want to raise about the trial?

The final question asked respondents if there were any other issues they wanted to mention relating to the trial. Twenty-four responses were provided at interim, with most indicating they didn’t have any more issues about the trial or appreciated the opportunity to give feedback (25%, n=24). Nine responses were provided in the post-trials survey with similar themes. Final broad themes included: communication and relationship with the service provider was better early in the trial link to medical software needs improvement billing was not straightforward daily monitoring of patients is time-consuming.

Isolated comments indicated anxiety created by equipment failure, and needing to expand to encompass more patients as there were other veterans that could have benefitted more than those selected and enrolled.


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HAPPENDIX H – CASE STUDY QUESTIONS

Case study visits were conducted in 14 practices across all four regions during November and December 2014 (Darling Downs and New England) and March 2015 (North Coast and Bayside). The visits included direct consultation with 42 trial participants, practice nurses and three GPs. A further 42 participants and 13 practices across all four regions were interviewed across the second and third round of case studies in 2016. The following provides the case study questions used with participants, carers and practices. The findings are detailed within the body of the report.

H.1 QUESTIONS FOR PARTICIPANTSNote: These questions will be asked verbally by the interviewer. Interview participants do not need to complete a written response.

1. Firstly, can you tell us about the care and support arrangements you receive from family or other carers?

2. Please tell us about your involvement in the In-home Telemonitoring for Veterans trial. How and when did you become involved? What were the reasons you decided to become involved? Did you have experience with using tablets or other technology before the trial? What did your family or carer/s think about you getting involved in the trial?

3. Were you on the CVC Program before you joined the trial? If yes, how has the level of care changed since starting the trial? If no, since starting the trial:

o Describe how the CVC program has changed your level of care?o Describe how the telemonitoring trial has changed your level of care?

4. Tell us about your initial reaction to being part of the trial?

5. What has been your experience of the trial so far?

6. Tell us about your care plan with your GP / practice nurse: Did you have one before the trial or as you started on the trial? Has your care plan been useful and how?


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7. Thinking about a typical week for you on the telemonitoring trial, tell us about: how you use the equipment and technology (e.g. frequency, times of the day) your contact with the practice and if relevant Tunstall nurses.

8. Can you tell us about your experience with using the technology? is it easy to use? how is the pace? is it convenient for you? do you remember to use it? are you given assistance if you have concerns?

9. Tell us about your experience with Tunstall or technical staff and nurses since starting the trial. Did Tunstall staff call you when you started on the trial?

o what did they call about? Did calls continue after the first contact?

o how often? how long did this continue? Has your experience with Tunstall staff changed throughout the trial? (e.g.

better/worse)

10. Similarly, when you started the trial, what has been your experience with the practice, your GP or nurse since starting the trial? At the start of the trial, did you have much contact from the practice, your GP or

nurse? o if so, how did this compare to Tunstall? (e.g. more/less contact)

Has this contact from your practice, GP or nurse continued? Has your experience with practice staff changed throughout the trial? (e.g.

better/worse)

11. Thinking about your experience with using the telemonitoring equipment have you felt any stress or anxiety when using the equipment? Please explain. if yes, did you discuss your concerns with your practice nurse, your GP or Tunstall

Healthcare? were they able to help overcome your concerns?

12. Do you think you are seeing the GP and/or practice nurse more often, less often, or about the same as before commencing on the telemonitoring trial? what do you think about this?

13. Have you had any instances where the readings have led you to contact your doctor or nurse?

14. Similarly, have you had any instances where the readings have led the practice, GP, nurse or Tunstall to contact you?


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15. Have you had any tele / video conferences using the telemonitoring equipment with your GP / nurse or Tunstall? if so, who initiated this? was it useful?

16. Can you tell us more about your thoughts and experience on the use of tele / video conferences? Do you think they are useful? (why/why not) Do you want to use tele / video conferences in the future? (why/why not) Have your thoughts on tele / video conferences changed over the course of the

trial? (e.g. better/worse)

17. As a result of monitoring, please tell us about whether you feel you are receiving: more frequent care? higher quality of care? more personal care?

18. Tell us what you think about monitoring and: the flexibility of how you get your health care? the timeliness of access to health care? the convenience of access to health care? (home vs. practice)

19. From your perspective, has the telemonitoring trial led to any key changes or outcomes with your health condition? What can you tell us about this? (e.g. visits to practice or hospital due to

monitoring/ readings, early identification of other conditions, better control of current condition)

20. Other than the monitoring technology, how is being involved in the trial different to the usual care you would get from your GP or practice nurse?

21. Are you travelling to the practice less frequently?

22. Thinking about your experience on the trial, to what extent has the following changed? Peace of mind? Knowledge of your health condition/s and treatment? Concerns about your health condition/s and treatment? Changes in behaviour (i.e. lifestyle, exercise, diet/food intake, compliance with

mediation, etc.)? Feelings of control over your health and/or other parts of your life? Effect on your loved ones and/or carers?


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23. Has the trial brought about any changes in financial costs for you?

24. Is there anything that could be improved to make telemonitoring better?

25. Are there any other issues that you have come across or want to discuss about the trial? Concerns? End of trial concerns? Opportunities? Other feedback?

H.2 QUESTIONS FOR PARTICIPANTS CARERThese questions are for the husband/wife/partner or carer of the participant

who is supporting the participant with their monitoring.

Note: These questions will be asked verbally by the interviewer. Interview participants do not need to complete a written response.

1. As a carer/support person to the participant, what can you tell us about your experience of the telemonitoring trial?

2. Have you provided any help with operating the telemonitoring equipment?

3. Thinking about the experience of the participant with the technology: is it easy to use? is it convenient to use? do they remember to use it?

4. Has using the telemonitoring equipment caused the participant any stress or anxiety? Please explain.

5. From your perspective, has the telemonitoring trial led to any key changes or outcomes with the participant’s health condition? What can you tell us about this? (e.g. visits to practice or hospital due to

monitoring/ readings, early identification of other conditions, better control of current condition)

6. As a result of the telemonitoring trial, please tell us about whether you feel, the participant is receiving: higher quality of care? more convenient access to care?


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7. Thinking about your experience with the trial and the telemonitoring equipment, to what extent do you feel the following has changed for you as a carer? Stress or anxiety? Peace of mind? Knowledge of or concerns about your own health? Changes in behaviour (i.e. lifestyle, exercise, diet/food intake)?

8. What has been the impact of telemonitoring on your time spent as a carer/support person?

9. Has the trial brought about any changes in financial costs for you?

10. Describe any changes in commitments (physical/time) for you as a result of the telemonitoring?

11. Tell us about the advantages of telemonitoring for a carer/support person?

12. Tell us about the disadvantages of telemonitoring for a carer/support person?

13. Is there anything that could be improved to make the telemonitoring experience better?

14. Are there any other issues that you have come across or want to discuss about the trial? Concerns? Opportunities? Other feedback?

H.3 QUESTIONS FOR PRACTICESThe following are the questions to be asked of the GP, Practice Nurse and Practice Manager. Not every question will be relevant to each person and so you will not be asked every question.

Note: These questions will be asked verbally by the interviewer. Interview participants will not be asked to complete a written questionnaire.

TRIAL DESIGN AND IMPLEMENTATION1. Tell us how you became involved in the in-home telemonitoring trial

2. What are the practice roles of the key staff involved in the telemonitoring trial? Administrative tasks Patient related tasks Accessing the data and viewing the trend reports Governance

3. Thinking about the contact have you had with Tunstall Healthcare and its co-monitoring team through the trial: How much contact have you had?


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How supportive have you found them to be? What was your experience with training and installation of equipment?

4. What has been your experience with the implementation of the trial so far from an administrative perspective? easy or time consuming? added to your workload? led to streamlining of processes?

5. What have been the impacts of using the telemonitoring equipment on your efficiency (time or direct cost) in delivering health care services to your trial participants? (Improved/Neutral/Declined)(a) If there have been improvements to your efficiency does this relate to:

Availability of vital signs data? Fewer ‘tests’ or ‘diagnostics’ needed? Dealing with issues as they are identified (e.g. telephone or

videoconferencing)? Able to see more patients in practice (as patients on trial not coming in to

practice for reviews) Other efficiencies?

(b) If you consider your efficiency has declined, what has led to this?

6. Can you describe how you integrate monitoring into you daily/weekly routine including the extent to which this is easy and/or challenging?

7. To what extent do you use video-conferencing with participants? If this is minimal can you identify obstacles to the use of video conferencing and / or make suggestions to increase its uptake?

8. Explain what you think have been the critical factors relevant to the uptake or success of telemonitoring by your practice? Size of the practice No. veterans participating Prior adoption of CVC No. nurses in practice Dedicated CVC nurse GP engagement and/or advocate Veteran distance from practice (rurality) Practice’s uptake of other technology Other

9. Explain what you think have been the key challenges to the uptake of telemonitoring by your practice? (criteria as above)

10. Overall, do you think a GP practice centred model (i.e. where monitoring and follow up resides with a GP practice/staff) is the ideal model? Why/Why not?


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IMPACT ON PRODUCTIVITY11. Tell us about the impact of the telemonitoring trial on yours and the practice’s

productivity (with respect to providing care planning, consultations and coordinated care to trial participants with chronic diseases)? have there been productivity gains? have there been more or less consultations / tests? has there been more or less of a role for nurses / GPs? have there been forced system changes? other factors?

12. Thinking about your telemonitoring participants and the trial, explain any changes in: the proportion of face to face versus virtual contacts? If so, what is the split

between GP/nurse? waiting times for GP practices? frequency of trips to the practice for veterans?

13. Thinking about your telemonitoring participants, what can you tell us about the balance of time spent by the GP and by the nurse on: program administration / non-appointment care coordination? patient care time?

14. Do you consider that the trial has changed your role as practice nurse, practice manager or GP in any way? In what way has it changed?

QUALITY OF CARE/ EFFECTIVENESS OF TELEMONITORING15. Overall, to what extent (improved/no change/declined) has the trial led to the

following for one or more of your patients (can you provide specific examples): Increased patients’ peace of mind (less stressed) Increased partner/carer/family peace of mind Stronger relationship between patient, carer, practice nurse and GP Enhanced information provision to patients’ specialist Increased monitoring to stabilise veterans’ health condition Medication titration or change Enabled early intervention / prevented exacerbation of health condition Avoided admission to hospital (unplanned hospitalisations) Avoided transfer to residential aged care Reduced the number of GP visits Enhanced referrals to specialists Enhanced referrals to other services (e.g. community nursing, allied health,

veterans home care) Patients taking greater responsibility for own health and/or caused them to make

lifestyle changes

16. If any of your participants have avoided admission to hospital due to the trial, can you tell us more about this?


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17. If any of your participants have avoided or delayed transfer to a residential facility due to the trial, can you tell us more about this?

18. Can you describe the key differences compared to ‘usual care’ the telemonitoring patients receive? What are the key differences for those who were already on CVC?

19.Have you noticed that there are certain patients and/or chronic conditions that the trial works best for and why? (can you provide specific examples) Age cohort Health conditions and co-morbidities - CHF/COPD/CAD/Diabetes/Other Distance from the practice or other access issues Family or carer support Veteran temperament, cognitive ability or personality type Prior familiarity with technology Veteran prior involvement with CVC

20. Are there certain patients and/or chronic conditions that the trial does not seem to work well for and why? (criteria as above)

21. Tell us about any change in risks (increasing / decreasing) as a result of telemonitoring for individual patients?

22. Tell us about any additional and/or unexpected benefits the telemonitoring trial may bring to your patients?

23. Thinking about the way telemonitoring or other services are delivered, over the time of the trial: have you changed any service delivery processes as a result of telemonitoring? have there been changes in ‘usual care’ for non-telemonitoring patients? have there been impacts on broader service delivery?

24. Thinking about your trial participants experience using the telemonitoring equipment, have any of your participants experienced more or less stress or anxiety? Please explain. if ‘yes’, how was this identified? did the patients discuss their concerns with you? were you able to help overcome their concerns?

25. From your observations, describe some of the impacts the trial has had on carers of veterans?

26. Overall, how successful do you think the trial has been so far?

27. To what extent has implementation met with your expectations? (A lot/neutral/not at all)


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28. What is your overall assessment of telemonitoring? (Valuable/some value/neutral/no value/negative impacts)

29. Overall, what do you think is working well in relation to the trial? Patient selection and recruitment Technology used (tablet, ICP triage manager, internet connection) GP centred model Payment / compensation for services Service provider (Tunstall) Communication with Tunstall Communication with DVA Interaction with other health services Other

30. Overall, what do you think is not working well in relation to the trial? (criteria as above)

31. Do you see potential for this model to be applied to: other health conditions? other populations? other service delivery situations?

32. Are there any other issues or opportunities that you have come across or want to discuss about the trial including ways it could be improved? End of trial concerns for any of your participants? (note DVA progress to date on

communicating exit strategy and step-down process etc)


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IAPPENDIX I – COST EFFECTIVENESS ANALYSIS-DETAILED CALCULATIONS

The methodology for cost effectiveness relied utilised data across two domains:

1. Costs incurred in implementing the trial for telemonitoring trial participants and the control group. These include establishment and operational costs in order to ensure that all cost elements of the services are accounted for in the analysis.

2. Outcomes for the telemonitoring trial participants and the control group (e.g. impacts of the trial on service utilisation, health and wellbeing).

Costs were considered at three levels:

1. Costs of the IHT trial (source: DVA cost centre reports). Data relating to the costs associated with the establishment of the in-home telemonitoring services (e.g. equipment, staff recruitment and training etc.) as well as recurrent costs of service delivery were analysed. The incremental unit costs for each service episode have been calculated to derive a total incremental cost per patient (trial participant).

Consideration of these costs also considered the extent to which the continuing costs of monitoring may be less than the cost experience of the trial (for instance due to the changing costs of the technology).

2. Broader service utilisation costs. Service utilisation costs for both trial and control site participants is critical to understanding the broader cost impacts (and potential benefits derived) from the trial. This includes analysis and quantification (in expenditure) of the following:

General Practitioner visits (source: DMIS data). The expectation from the trial was that there would be reduced physical visits to health professionals as a result of regular monitoring and improved chronic condition management, including fewer in-person visits to the general practice. The evaluation sought to quantify the extent to which GP visits and costs varied between the trial and control cohorts

The evaluation also considered the extent to which there have been changes in costs experienced at participating practices as a result of the trial

Utilisation of acute hospital services (source: DMIS data). One of the aims of the trial was to reduce preventable admissions to hospital and to support this aim, trial participants were selected for their high risk of hospitalisation. The evaluation has quantified the extent to which hospital utilisation and associated costs varied between the trial and control cohorts

Utilisation of specialists (source: DMIS data). An expectation from the trial was that telemonitoring could be an opportunity to provide more information to specialists to enhance and support management of the patient. It was not anticipated that the trial would impact on the utilisation of specialists. The evaluation has quantified the extent to which specialist visits and costs varied between the trial and control cohorts


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Pharmaceutical use (source: DMIS data). The introduction of telemonitoring was not anticipated to significantly impact the amount or cost of pharmaceutical use for participants, certainly not in the short term. The evaluation has quantified the extent to which pharmaceutical use and costs varied between the trial and control cohorts

Allied health services (source: DMIS data). The trial was not anticipating significant impact on the utilisation of other services, such as DVA’s Veterans’ Home Care (VHC), community nursing, or allied health services. The evaluation has quantified the extent to which the utilisation of allied health services varied between the trial and control cohorts

3. Outcomes Assessment of the outcomes has been provided in the preceding chapters and included here in the context of its application to the cost effectiveness analysis.

The findings were then translated into the equivalent annualised estimated impact of the trial.

I.1 IHT TRIAL COSTSTrial operational costs were based on data available through the DVA financial system. These costs represented all expenditure from trial commencement (April 2013) through to June 2016 (actual) and are estimated through to trial cessation. The data EXCLUDES medical and related services for the care of participants. Table I1 provides a summary of the costs of the trial.

Table I1: Summary of trial costs

Cost item To June 2016 Estimated to End Project

Trial Operational Costs

Equipment Provider-Trial Services $2,089,782 $2,390,384Practice Payments-Trial Monitoring-UP20-UP21

$50,600$404,800

$76,800$457,400

Total Operational Costs $2,545,182 $2,924,584

Trial Management Costs

Practice Payments-Sign on $36,600 $36,600

Clinical Reference Group (CRG) $10,211 $10,211Equipment Provider-Management, Trial Initiation, Recruiting and Exit Costs

$2,127,247 $2,148,951

Evaluation $254,638 $475,000Primary Health Networks $117,499 $117,499Total Management Costs $2,546,195 $2,788,261

It is noted that:

the contract arrangements with the equipment provider (Tunstall) provided for payments for activities that did not directly relate to service delivery such as KPI reports, safety reports and various interim and final summary reports. These have been included as “trial management costs”


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some cost components associated with trial initiation costs may be applicable to the operational costs as it included recruitment/assessment as well as patient and GP training. However, as these were not able to be easily identified, for the purposes of analysis these have been entirely included as trial management costs

the one-off practice payments made at the time of trial commencement, CRG and Primary Health Networks costs are classified as “trial management costs”.

the service provider notes that some trial participants reported that one or more of their devices was not necessary. This has not been factored into the cost-effectiveness analysis, but is discussed as part of future model design as an area for potential cost saving (see Chapter 9 of final report)

the service provider notes that the original specifications for the equipment and system included high definition videoconferencing capability. Less costly, yet adequate alternatives were available but not utilised. This has not been factored into the cost-effectiveness analysis, but is discussed as part of future model design as an area for potential cost saving in Chapter 9.

The trial operational costs are considered as costs that might be incurred should in-home telemonitoring be adopted as an ongoing service and cover the provision, maintenance and calibration of equipment and the cost of monitoring patients via the quarterly payment/client to practices (using the UP20/UP21 item numbers). Note that the payment/client costs have also been modelled below on the basis of being incorporated with the existing CVC payment.

In broad terms, these data are important additional costs for treating participants requiring telemonitoring. For the purpose of this analysis it is considered reasonable to derive an add-on cost on a per client (trial participant) basis. Based on the trial data there were 150,316 days of telemonitoring provided through to 30 June 2016 (including those days for participants that exited early) at the equivalent approximate operational cost of $1,524/quarter or $16.93/day for each participant.

Across the 167 analysed trial participants, these participants were active participants for an average of 720 days each (out of a maximum of 730 days). Thus, the net cost for managing the 167 “in-scope” telemonitoring participants was in the order of $2,035,663 or $12,190/participant. This represents an additional cost for participant treatment.

I.2 IHT SERVICE UTILISATION-NON-HOSPITALThere was service utilisation data (and associated costs) available for six service delivery streams, excluding hospital services. To identify an estimate for the cost differential pre- and post- and to then estimate the impact of these changes on the cost of managing the participating participants the evaluation of cost effectiveness has focussed on four of these streams: GP services, specialist services, pharmaceuticals and allied health services. These groups represented the vast majority of services (and costs) for participant services.

Table I2 provides relevant statistics for each of these streams (some data has been presented elsewhere in this report but is replicated for simplicity).


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Table I2: Analysis of service utilisation – non-hospital

Service StreamGCH CVC IHT


Ave # Visits/participant/quarter

(% change)

3.76 4.6323.1%

3.99 4.6215.7%

4.1 4.233.1%

Cost/participant/quarter(% change)

$207 $29240.9%

$209 $27732.6%

$199 $22010.2%

Total # of visits/quarter 684 696Total Expenditure/quarter(whole of trial estimate)

$33,293$266,300

$36,683$293,500


$226 $30033.0%

244 $34039.3%

$231 $27017.2%

Total # of visits/quarter 345 385Total Expenditure/quarter(whole of trial estimate)

$35,962$287,696

$40,515$324,100


$58 $48-16.8%

$60 $52-12.8%

$67 $65-2.6%

Total items/client/quarter 2.7 2.3 2.8 2.6 2.7 2.8Total Expenditure/quarter(whole of trial estimate)

$27,016$216,128

$27,099$216,792


$286 $3129.3%

$330 $37413.1%

$374 $42313.3%

Total services/client/quarter 4.3 3.9 5.0 4.8 5.6 6.0Total Expenditure/quarter(whole of trial estimate)

$59,946$479,568

$67,871$542,968

IN RELATION TO GP SERVICES:

baseline costs and average visits per participant/quarter were largely similar at baseline across the three cohorts

the average costs and visits per participant/quarter all increased through the trial period

the proportional increase in the average costs and visits per participant/quarter was much smaller for the IHT participants.

Estimating potential savings on GP services from the trial has relied on identifying reasonable assumptions:

the comparison groups were similar in profile to the IHT group, a reasonable assumption given the demographics

in the absence of the trial, average number of visits/quarter for the IHT cohort may have increased consistent with the CVC group (i.e. 15.7% increase rather than 3.1%)


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in the absence of the trial, cost/participant/quarter may have increased consistent with the CVC group (32.6% increase rather than 10.2%).

Thus, on the basis of applying both these numerical assumptions, the average cost/participant/quarter for IHT would have risen to $264 (compared to $220) and total number of visits/quarter to 791 (compared to 696). Translating this across the 167 in-scope participants and to the full trial period suggests a total cost of around $352,700 (($264x8 quarters) x 167 participants). This represents an additional $59,200 over the estimated $293,500 actual expenditure on GP services.

IN RELATION TO SPECIALIST SERVICES:

baseline costs/participant/quarter were largely similar at baseline across the three cohorts

the average costs and visits per participant/quarter all increased through the trial period

the proportional increase in the average costs and visits per participant/quarter was much smaller for the IHT participants.

To estimate potential savings on specialist services from trial has relied on identifying reasonable assumptions:


in the absence of the trial, cost/participant/quarter may have increased consistent with the CVC group (39.3% increase rather than 17.2%).

Thus, on the basis of applying this numerical assumption, the average cost/participant/quarter for IHT would have risen to $322 (compared to $270). Translating this across the 153 in-scope participants and to the full trial period suggests a total cost of around $394,128 (($322x8 quarters) x 153 participants). This represents an additional $70,028 over the estimated $324,100 actual expenditure on specialist services.

IN RELATION TO PHARMACEUTICAL SERVICES:

all groups reduced pharmaceutical cost/participant/quarter, although the IHT group reduced by the smallest percentage (2.6% compared with 16.8% for the GCH and 12.8% for the CVC groups)

the baseline cost/participant/quarter for the IHT group was higher compared to the comparison cohorts

items/client/quarter reduced for the GCH and CVC groups but increased marginally for the IHT group

total expenditure for the IHT group was essentially constant for the IHT between baseline and trial periods.

no adjustments were made for pharmaceutical services as part of the cost effectiveness analysis.

IN RELATION TO ALLIED HEALTH SERVICES:

The analysis of allied health service utilisation included consideration of ALL allied health services and separate analysis of a subset of allied health services relevant to the chronic conditions of trial patients. Changes in utilisation between baseline and trial were largely consistent between these two separate analyses. It was our view that, in respect to the trial impact


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the cost/participant/quarter has increased for all three cohorts. The increase for the IHT group was consistent with the increase for the CVC comparison group but higher than observed for the GCH group

the baseline cost/participant/quarter for the IHT group was higher than the two comparator groups

total services/client/quarter decreased for the GCH and CVC groups but increased for the IHT group (and was higher compared to the comparison groups)

total expenditure/quarter increased for the IHT group consistent with the observations above.

Translating these observations, it is noted that the IHT group incurred around $63,400 additional expenditure compared with the baseline measures (based on the targeted allied health groups). We note that any change in the pricing of allied health services over the course of the trial was likely to be insignificant, as they were not subject to inflation. While it is not necessarily appropriate to directly attribute this change to the impact of the trial, we have included this in the final summary of costs and benefits as an indicator of the possible effects (due to more focussed attention to the clients’ needs). We did not include the estimated cost of increases in allied health services more broadly.

I.3 IHT SERVICE UTILISATION-ACUTE HOSPITALAcute hospitalisations represent a significant cost to DVA and disruption to the day to day lives of participants. Where these can be reduced for participants due to early alternative interventions, such reduction is of benefit to both parties. Table I3 provides relevant data for hospital admissions pre-and during the trial. Utilisation of public and private hospital is presented separately.

Included in the analysis is consideration of clinical complexity. Consideration of traditional measures such as average length of stay, number of admissions etc demonstrate little change between baseline and trial periods. An additional approach was to consider the extent to which the types of admissions changed. Clinical complexity is based on utilising the cost weights per Diagnosis Related Group to assign a measure of the intensity of resources used to treat the person, with the cost weight increasing with clinical complexity.


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Table I3: Analysis of acute hospitalisationHospital Service GCH CVC IHT


Public Hospital Services

Admissions/participant/quarter 0.3 0.5 0.3 0.4 0.3 0.3

Veterans requiring admission (out of 167) 53 67

Admissions 116 145

Cost/participant/quarter% Change

$1,923 $3,39776.7%

$1,990 $2,34717.9%

$1,514 $1,340-11.5%

ALOS/Admission/quarter 4.9 4.8 5.2 4.9 3.9 3.9

Total Expenditure/quarter(whole of trial estimate)

80,261$642,100

88,928$711,400

Complexity Index% Change

1.09 1.210.1%

1.15 1.13-1.7%

1.09 1.04-4.6%

Private Hospital Services

Admissions/participant/quarter 0.5 0.6 0.4 0.5 0.5 0.7

Veterans requiring admission (out of 167) 117 121

Admissions 461 603

Cost/participant/quarter% Change

$2,038 $2,84739.7%

$1,846 $2,95860.2%

$2,090 $2,35212.5%

ALOS/Admission/quarter 4.1 4.5 4.0 5.0 3.2 3.3

Total Expenditure/quarter(whole of trial estimate)

$244,523$1,956,20

0

$280,557$2,244,50

0Complexity Index% Change

1.09 1.199.2%

1.09 1.111.8%

0.99 0.91-8.1%

IN RELATION TO PUBLIC HOSPITAL ADMISSIONS:

baseline costs and average admissions per participant/quarter were largely similar at baseline for GCH and CVC but IHT was already lower

the average costs/participant/quarter increased for GCH and CVC through the trial period. IHT reduced

ALOS reduced for GCH and CVC but remained stable for IHT complexity increased for GCH, reduced slightly for CVC and reduced by 4.6% for IHT not all participants required hospitalisation.


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Estimating potential savings on public hospital admission from trial has relied on identifying reasonable assumptions:


in the absence of the trial, average clinical complexity for the IHT cohort may have decreased consistent with the CVC group (i.e. 1.7% decrease rather than 4.6%)

in the absence of the trial, cost/participant/quarter may have increased consistent with the CVC group (17.9%% increase rather than a reduction of 11.5%).

Thus, on the basis of applying both these numerical assumptions, the average cost/participant/quarter for IHT would have risen to $1,785 (compared to $1,340) and the clinical complexity adjustment (from a 4.6% reduction would only reduce by 1.7% to 1.07. Assuming the clinical complexity change was uniform across all cases this would add 3% to the costs. Translating this across the 67 patients requiring public hospitalisation this suggests a total cost of around $985,500 (($1,785x8 quarters) x 67 participants x 1.03 for clinical complexity increase). This represents an additional $274,100 over the estimated $711,400 actual expenditure on public hospital services.

IN RELATION TO PRIVATE HOSPITAL ADMISSIONS:

baseline costs and average admissions per participant/quarter were largely similar at baseline for GCH and CVC but IHT was already lower

the average costs/participant/quarter increased for cohorts ALOS increased for all cohorts complexity increased for GCH and CVC but reduced by 8.1% for IHT not all participants required hospitalisation.To estimate potential savings on public hospital admission from trial has relied on identifying reasonable assumptions:


in the absence of the trial, average clinical complexity for the IHT cohort may have decreased consistent with the CVC group (i.e. 1.8% increase rather than a decrease of8.1%)

in the absence of the trial, cost/participant/quarter may have increased consistent with the CVC group (60.2%% increase rather than 12.5%).

Thus, on the basis of applying both these numerical assumptions, the average cost/participant/quarter for IHT would have risen to $3,350 (compared to $2,352) and the clinical complexity adjustment (from an 8.1% reduction would increase by 1.8% to 1.01. Assuming the clinical complexity increase was uniform across all cases this would add 10% to the costs. Translating this across the 121 patients requiring hospitalisation this suggests a total cost of around $3,567,100 (($3,350x8 quarters) x 121 participants x 1.1 for complexity increase). This represents an additional $1,610,900 over the estimated $1,956,200 actual expenditure on private hospital services. It is noted that the CVC cost/participant/quarter has risen substantially and perhaps a much lower modelled increase could be considered.

I.4 COST IMPACT OF TELEMONITORING FROM PATIENT OUTCOMESA number of clinical measures and indicators have been identified to determine whether the in-house telemonitoring innovative initiatives have been successful or not in comparison with alternate health services. These measures have been collected throughout the trial and are identified as follows:


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1. Quality of life. For the evaluation, the AQoL-8D survey (a self-report tool) was used to seek information from survey respondents in relation to eight dimensions of quality of life. The tool provides an overall ‘utility score’ and ‘dimension score’ that enables comparison to other groups as well as measure change over time.

2. Psychological wellbeing. The psychological wellbeing of telemonitoring participants (and the matched control group) was assessed using the K10 questionnaire and qualitative feedback received through case studies and practices (at baseline and interim stages). The K10 questionnaire is a tool that gives an indication of likely mental health status and, in particular, levels of stress/distress based on self-assessment by the respondent.

3. ICP triage manager recorded interventions. The number and type of interventions are indicators for the clinical effectiveness of the trial.

The findings from these patient outcome instruments has been discussed elsewhere in this report. In the context of cost effectiveness, the measures derived can be linked to cost effectiveness. However, as noted elsewhere in this report, no statistically significant differences were identified for IHT participants. Consequently, it is concluded that the application of weighted scores for application to cost effectiveness measurement would not identify relevant statistically valid adjustments to the derived service utilisation-based findings as set out in the previous section.

I.5 ANNUALISED FINANCIAL IMPACT OF IHTThe calculations in the previous sections identified the cost effectiveness of the overall trial that indicated approximate cost neutrality. An additional consideration was to analyse the impact on the annual cost of providing health care to DVA clients should an IHT service be available through the CVC program. Based on continuous IHT the previous analysis suggests that cost neutrality would continue (since daily IHT costs would be constant and the observed reductions in service utilisation and/or lower complexity hospital episodes would not change).

An alternate approach is to contemplate the impact of introducing IHT for a defined period. Such an approach was highlighted by the positive impact of IHT (from a cost perspective) for those clients who were simultaneously enrolled in the CVC Program (‘new to CVC’) and the anecdotal feedback from clinical staff suggesting that the benefits of IHT tended to plateau once the condition of the participant stabilised. Although the trial did NOT seek to test the impact of variability with IHT monitoring periods, two alternate scenarios are presented below in Table I4-the first for the use of IHT for an initial period of three months and the second for the use of IHT for an initial six months. Further consultation with clinicians would need to be undertaken to ascertain the appropriateness and criteria for using IHT on a time-limited basis. The analysis is based on the data derived from the trial and in accordance with the methodology set out above.


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Table I4: Annualised per client cost-benefit (year 1)

Item Per Day Impact

Annualised Cost/Benefit Per Client (Year 1)

Ongoing Monitoring

Monitoring for 3

months

Monitoring for 6

months

Telemonitoring operational costs (including payments to GPs)

-$16.93 -$6,179 -$1,524 -$3,047

GP services payments $0.49 $179 $179 $179

Specialist services payments $0.58 $212 $212 $212

Pharmaceutical services - - - -

Allied health services -$0.52 -$190 -$190 -$190

Private hospital costs $13.40 $4,891 $4,891 $4,891

Public hospital costs $2.28 $832 $832 $832

Net benefit (cost) -$0.70 -$256 $4,400 $2,877

Return on Investment (ROI) -0.04 2.89 0.94

From Table I4 we note that based on the cost/benefits identified from the overall trial: full ongoing monitoring would incur an annual additional cost to DVA of $256 per

client monitoring for an initial six month period could provide a net cost benefit to DVA of

$2,877 per client-a return on investment of 0.94 in year 1 of IHT monitoring for an initial three month period could provide a net cost benefit to DVA of

$4,400 per client-a return on investment of 2.89 in year 1 of IHT.It is noted that if limited-time IHT was found to be clinically acceptable and assuming the reduced service utilisation is continued beyond year 1, IHT would not be used in year 2 and beyond and therefore additional savings would be achieved in these subsequent years. It is also noted that these calculations do not take account of any DVA internal costs for managing an IHT program or any costs incurred by clients.

Excluding GP services payments (an option could be to incorporate these payments into the existing CVC payment) would improve the derived financial benefits as set out above. This cost accounted for approximately $3.03/participant/day. Thus, with full monitoring and no separate GP service payments, the ROI would improve from -0.04 to a positive ROI of 0.16.

An alternate consideration is to recognise that the annual additional net cost for full IHT monitoring was found to be $256/client. Based on the operational costs of $6,179 (and achievement of the adjusted service utilisation) a saving of 4.2% on the cost of operating IHT would achieve a cost neutral outcome but with a range of accumulated benefits to


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some clients (e.g. greater piece of mind, reduced hospitalisation and a reduction in other service utilisation).


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