Launch of the WSDAN evidence database
The WSDAN evidence database is a searchable online directory that brings together published and unpublished materials related to the impact and evidence of telehealth and telecare in the management of people with long-term conditions. It was launched to the public at the WSDAN Telehealth and Telecare Roadshow at the Leeds Hilton on 11 June 2009.
Who is the database for?
Understanding ‘what works’ in terms of telehealth and telecare applications in the management of patients with long-term conditions is problematic as there is rarely an independent source of information that might enable commissioners and professionals to understand the benefits and costs of investing in and working with systems using innovative technologies. While the WSDAN evidence database will not provide all the answers, it has been set up to guide those seeking some external validity to such decisions by giving them access to information on the potential benefits and impact of telecare and telehealth.
What information is included in the database?
The information provided in this database is a work in progress and has been specifically tailored to enable people to access appropriate and relevant evidence on the impact of telehealth and telecare on the management of people with long-term conditions. Currently, more than 200 sources of information have been uploaded onto the WSDAN evidence database, though we expect that this number will double by the end of the summer. Each listing contains reference to the source material, a summary of the evidence, and – where possible – links to the evidence itself. The database is updated quarterly, and the aim over the next year is to build a map of the evidence-base as part of a systematic review.
How is the database used?
- The WSDAN evidence database is designed to be an easy-to-use facility that can be searched by:
- the type of long-term condition and/or client group
- the purpose of the technology used
- the quality of the evidence available.
Category 1: Type of long-term condition
For those wishing to examine the evidence-base for a particular condition, the WSDAN evidence database provides a drop-down list of key conditions. Long-term conditions included in the database are those understood to be chronic conditions that require ongoing management over a period of years or decades. This includes a range of health conditions including non-communicable diseases (such as cancer and heart disease); some communicable diseases (such as HIV/Aids); mental health disorders (from depression through to more acute conditions such as schizophrenia) as well as ongoing physiological impairments (such as blindness, joint disorders and acute back pain).
The database also includes evidence on the impact of telecare and telehealth to two ‘client groups’ – the frail elderly, and children and adolescents. Learning disability is also included as a seperate category, as is obesity. While none of these can be strictly regarded as long-term conditions, they are included to ensure the relevance of the database to both health and social care users.
Category 2: Purpose of the technology
The available technologies are represented by four broad categories of telecare and telehealth systems, plus an additional category where such evidence is combined:
- home-based medical applications
- remote monitoring of vital signs
- safety and security monitoring
- information and support provided via telephone and the internet
- combined approaches
These categories have been adapted from those used in a recent and comprehensive systematic review of the benefits of home telecare by James Barlow and colleagues . The categories chosen are intentionally non-specific to any particular telehealth and telecare equipment modality, such as those used by NHS PASA in its National Framework Agreement for Telecare. The database also does not differentiate between references examining the impact and evidence on individual outcomes (eg, health outcomes or user experiences) and those examining system outcomes (such as cost-effectiveness or impact on emergency admissions and bed utilisation).
Quality of evidence
When assessing the evidence it is important to understand its quality in order to make an informed decision on its value. To enable some judgements to be made on the quality of data, we have created a ‘hierarchy’ of evidence to which studies will be allocated where known.
1. Evidence of the highest quality
This category represents the evidence that would be most likely to be accepted for inclusion in a systematic review. It includes systematic literature reviews; randomised controlled trials/clinical trials; and peer-reviewed qualitative studies (minimum 80 participants) . Such information is typically used to make evidence-based decisions.
2. The wider evidence base
This category represents the evidence that would most likely not be accepted for inclusion in a systematic review. However, it represents a body of knowledge that is typically used to make evidence-informed decisions. It includes:
- qualitative studies (peer reviewed, less than 80 participants)
- case studies / examples / early findings from pilots / research in progress
- opinion surveys / patient surveys / questionnaires / focus groups
- theory / economic modelling
- policy documents and papers
However, it is important to note that the WSDAN evidence database makes no specific judgements on the quality of this wider evidence, which may include publicly available evidence published or sponsored by telecare and telehealth vendors. Users must treat this wider evidence with caution in terms of both its quality and potential subjectivity. Through listing sources of information in the wider evidence base, WSDAN is not in any way accrediting or attributing credibility or value to the information provided.
Much of the evidence-base, for example from local pilots, is unpublished, and WSDAN makes no claims to the database being – as yet – a comprehensive resource; it is intent on building the evidence in its directory. For this reason, WSDAN welcomes submissions of published and unpublished evidence that is missing from this database and should be considered for inclusion.
Submit information to quoting ‘EVIDENCE’ in the subject field.
Nick Goodwin is Senior Fellow, The King’s Fund, and co-project lead for WSDAN
. Barlow J, Singh D, Bayer S, Curry R (2007). ‘A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions.’ Journal of Telemedicine and Telecare, vol 13, pp 172–9