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Trust in partnership develops a system which triggers alerts and helps clinicians to provide early interventions for dementia patients at home, reducing unnecessary A&E attendances

Challenge

    • More than 930,000 people have dementia in the UK
    • Current cost to the UK economy of caring for people with this condition is £30 billion
    • Deliver better support to dementia patients and their carers at home and reduce unplanned hospital admissions or GP visits

Action

    • Established the Technology Integrated Health Management (TIHM) system to enable early intervention by clinicians
    • Installed internet enabled devices, spanning sensors, monitors and trackers in homes to collect physiological/ behavioural/environmental data 24/7
    • Alerts are followed up by a clinical monitoring team working with NHS services, Alzheimer’s Society etc
    • Used machine learning algorithms to identify early signs of a urinary tract infection

Result

    • Resulted in 20,040 alerts being triggered during March to December 2017
    • Helped user feel safer and better supported
    • Carers felt reassured about the health of the person they are caring for and were less likely to unnecessarily rush to A&E/GP
    • Facilitated sharing of data with GPs for more informed and faster clinical decision making

Outline:

TIHM for dementia is a pioneering study using internet enabled devices in combination with artificial intelligence to improve support for people with dementia, who live at home, and their carers.

The study is led by Surrey and Borders Partnership NHS Foundation Trust and involves a collaboration of partners, including the Alzheimer’s Society, University of Surrey, Royal Holloway University of London and eight technology SMEs More than 400 people with dementia and their carers have been recruited on to the randomised control study from across Surrey and NE Hampshire.

A network of 21 small devices spanning sensors, monitors and trackers has been installed in homes collecting physiological, behavioural and environmental data 24/7, including blood pressure, temperature, hydration, movement inside and outside of the home. The data is analysed and presented on a digital dashboard and monitored by a Clinical Monitoring Team.

If the technology identifies a problem, an alert is triggered and investigated by the team who will liaise with other NHS services, the Alzheimer’s Society, social services or the police to provide support. As well as identifying an immediate crisis, TIHM uses machine learning to identify if a person’s health or behaviour is deviating from their ‘normal’ patterns which could indicate they are becoming unwell and would trigger an alert.

Ambition:

More than 930,000 people have dementia in the UK with that figure set to rise to well above one million by 2025. The current cost to the UK economy of caring for people with this condition is £30 billion. One in four hospital beds are currently occupied by a person with dementia but 22 per cent of unplanned admissions are for conditions that are preventable. With no prospect of a cure, there is an urgent need to find better and more efficient ways of supporting this group of people.

TIHM aims to:

• Improve quality of life for people with dementia, giving them the confidence to stay in their homes for longer

• Reduce pressure on carers who are at risk from burnout which can lead to early admission to care homes for people with dementia

• Improve early intervention to help people avoid a health crisis and reduce their need for hospital and care home admission

• Develop machine learning algorithms to support early intervention

• Reduce pressure on acute NHS services

• create a new technology integrated clinical pathway that targets resources at areas of need

• Create a scalable solution that can also be adapted to support people with other complex health conditions

• Create a system that is user led

Outcome:

A final report on TIHM will be published in July.

Early indications show:

• TIHM has improved quality of life for people with dementia: 20 Trusted Users recruited to provide ongoing feedback report they feel better supported, safer and less isolated using TIHM. Carers say they are more reassured about the health of the person they are caring for and less likely to unnecessarily rush to A&E or their GP. They also value being able to share data collected by TIHM with GPs for more informed and faster clinical decision making

• An independent report by the University of Surrey evaluating the study states a large majority of people with dementia and their cares would recommend TIHM

• Pioneering machine learning algorithms have been developed to successfully identify early signs of a urinary tract infection, a top five cause of hospital admission among this group

• TIHM is providing clinicians with actionable data to support early intervention: In the period March to December 2017, 20,040 alerts were triggered.

The most common related to: blood pressure, dehydration, wandering, body temperature, UTI, agitation and pulse.

• A technology integrated pathway has been successfully created, filling a crucial gap in support for people with dementia

• TIHM is a plug in and play system that is scalable and adaptable

Spread:

TIHM for dementia is an ambitious collaboration that has brought together clinicians from Surrey and Borders Partnership and technicians from the University of Surrey’s 5G Innovation Centre and Royal Holloway University of London, as well as innovators from eight SMEs, to develop a pioneering and secure system to support people with dementia.

These different groups have been able to share information and learning that has not only supported the development of TIHM but is also leading to joint developmental work in other areas.

The following examples show how the TIHM collaboration, led by Surrey and Borders Partnership, is also working with other parties to spread learning and successes.

It has:

• submitted a business case to a local STP to use TIHM to address gaps in the clinical workforce by supporting people with long term conditions

• is in talks with two more STPS about adapting TIHM to meet local needs

• is working with Surrey County Council to generate funding to adapt TIHM for people with learning difficulties TIHM has attracted visits from Singapore’s National Medical Research Council, from hospitals and universities across Denmark, Sweden and Finland and from the Taiwan Science and Technology Division.

Value:

Counterfactual analysis of the five case studies below show that for these alone, the potential costs avoided following a TIHM intervention total £57,539. Clinical judgement has been used to assess the likely medical intervention needed had TIHM not intervened and these interventions have been accurately costed.

This approach is being applied across TIHM

• A 77 year old man, who had gone missing and was developing high blood pressure, was quickly found using TIHM tracker and given the necessary care

• High blood pressure in a 78 year old woman triggered an alert. Historical data collected by TIHM meant GP could immediately prescribe medication. TIHM then identified medication was causing frequent urination and dehydration, enabling GP to optimise medicine

• An 87 year old woman triggered a low weight alert. It emerged she had been vomiting. She was prescribed anti-reflux medication by her GP

• An unusual blood pressure reading for a 90 year old woman caused an alert. It was discovered she had taken an accidental overdose. The carer was alerted and took her straight to A&E

• A 74 year old woman, just discharged from hospital following treatment for Pancreatitis, triggered a UTI alert. The GP was contacted and within two hours she was on anti-biotics, helping avoid re-admission to hospital.

Involvement:

TIHM for dementia has embarked on an extensive engagement programme with all stakeholders:

• Workshops were held to involve everyone, from clinicians, people with dementia and carers, technicians from universities, technology providers, telecare and voluntary groups, in the design of TIHM

• Two Living Labs were created at the University of Surrey for training and to showcase the technology in a ‘real home’ setting

• A 20 strong group of Trusted Users (people with dementia and carers) were invited to provide ongoing feedback about the technology, monitoring and deployment processes throughout the study, significantly helping the collaboration to fine tune operations.

• TIHM presentations were given to CCGs, GPs, patient groups, dementia networking groups, social services, local councils, the police, internal older adult teams and local voluntary groups. Feedback was used, were possible, to refine processes

• Presentations were given at more than 35 high profile events to share learning, including: NHS England Expo, Kings Fund Digital Health Congress, IoT UK events, Long Term Conditions Summit, UCL Institute for Digital Health Conference, Confed 17 etc.

• TIHM has been featured twice on BBC Breakfast news, and on BBC News, Sky News and in the Times, Guardian, Mail on Sunday, Daily Express, the BMJ and other health and technology journals, and repeatedly in the local media.

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