The BMJ has just published an open access paper entitled “Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls” (BMJ2013;347:f4585, Steventon et Al). It reaches the rather depressing headline conclusion that telephone coaching did not reduce unplanned hospitalisations and if anything increased them.
This looks to fly in the face of the apparently less academically rigorous recent claims by the Leicester City CCG and Totally Health, that they reduced hospitalisations significantly, saving some £353,000 over a 30 week period with a cohort of between 47 & 50 patients that we reported recently.
However reading on, perhaps a key passage, in the conclusion, is : “Based on a systematic review and subsequent studies, including the present study, standard telephone health coaching seems unlikely to lead to reductions in hospital use, without the addition of other elements such as telemonitoring, shared decision making for preference sensitive conditions, or predictive modelling.” (So perhaps Totally Health should have mentioned Spirit Healthcare in their press release as without the telehealth service, possibly the huge saving would not have been achievable?)
The next two sentences in the BMJ paper’s conclusion make interesting reading too: “More care coordination might also be needed. Unless health coachers have established relationships with other clinical staff, new interventions could prove to be additions to existing patterns of service use, rather than create efficiencies.”
I’m probably reading far to much into this than I should. However one interpretation of this conclusion is that if you take a new technology-based service, plonk it down into an existing complex health community, without any attempt at integration with existing services or without recognising any new services that might be needed to support it, then it won’t deliver much, if any, benefit. Or put simply: technology is not a simple intervention. Now where have I seen that conclusion before?
Hat tip to Mike Clark for alerting me to this paper.
PS if you’re a bit rusty on the difference between a cohort study and an RCT, Wikipedia has a concise explanation.