Advice
Clinical and technical evidence
Clinical and technical evidence
A literature search was carried out for this briefing in line with the interim process and methods statement. This briefing includes the most relevant or best available published evidence relating to the clinical effectiveness of the technology. Further information about how the evidence for this briefing was selected is available on request by contacting mibs@nice.org.uk.
Published evidence
Four studies including 26,320 participants are summarised in this briefing. All 4 are pilot studies, 3 relating to Broomwell Healthwatch and 1 to MEOMED and all were done in the UK. One is an abstract reporting the results of a large pilot study (n=25,346) over 4 years.
Using these services resulted in improvement of appropriate referrals and this was found to be cost saving. The average time to receive results was around 2 hours.
Table 5 summarises the clinical evidence as well as its strengths and limitations.
Overall assessment of the evidence
Broomwell Healthwatch and MEOMED were the only services for which there is publicly available information. These services report results from pilot studies in the NHS and focus on assessing the clinical utility of the service.
The primary outcome for all of the studies is the proportion of changes to care plans. The potential utility of the service can be shown by evaluating differences between the remote service's recommendation and the care pathway prescribed by the practitioner.
There is no direct within-study comparison between the services in this briefing. There are also no comparisons between the services and other technologies, such as automatic interpretation services. In the evidence included in this briefing, there was no follow‑up of outcomes to ensure that care pathway recommendations made by the service resulted in improved clinical outcomes. There are also no comparisons of results between different clinical commissioning groups or regions of the UK.
|
Study size, design and location |
32 people with chest pain or transient loss of consciousness in a 6‑week pilot study in Bridgwater Community Hospital, Somerset, UK. |
|
Intervention and comparator(s) |
Broomwell Healthwatch compared with automatic referral to acute trust. |
|
Key outcomes |
16% of ECGs had abnormalities not detected by practitioner (that were identified by Broomwell Healthwatch). |
|
Strengths and limitations |
The study did not report any power calculation. This was a single-centre pilot and so is not representative of other types of practice, such as GP surgeries. No economic information is reported and outcomes are limited to descriptions of the prescribed care plan. |
|
Study size, design and location |
24,541 12‑lead ECGs and 805 1‑lead ECGs, in a 4‑year pilot study in the Greater Manchester and Cheshire Cardiac Stroke Network, UK. |
|
Intervention and comparator(s) |
Broomwell Healthwatch compared with standard care. |
|
Key outcomes |
In 15,698 people with symptoms (from 24,541 12‑lead ECGs), 87.5% were recommended for treatment in primary care; 6.5% were recommended for secondary care and 6% recommended for emergency care. In people with symptoms from lead‑I ECGs, 96% were recommended for treatment in primary care. All ECGs were reported within 2 hours of their receipt. The prevention rate of secondary care referrals was 65.8% of the total cases (95% confidence interval 61.6 to 65.8%) and the extrapolated gross savings were calculated to be over £300,000. |
|
Strengths and limitations |
The study included a large number of ECGs, over 4 years, in multiple GP surgeries. Only the abstract is freely available, so there is no detail on the study methodology. |
|
Study size, design and location |
A total of 373 ECGs from people aged 8 to102 years, in a 6‑month pilot study in Lancashire and Cumbria (NHS Northwest), UK. |
|
Intervention and comparator(s) |
Broomwell Healthwatch compared with standard care. |
|
Key outcomes |
There were 76 changes made to care pathways. In total, 14 unnecessary referrals to secondary care were avoided and 18 people who the practitioner planned to only see in primary care were referred to secondary care. |
|
Strengths and limitations |
The study included results from 8 GP surgeries and 2 walk‑in centres and included people with a wide age range. Rates of use varied between practices so economic outcomes are not given. |
|
MEOMED Ltd Process Improvement Audit, Hall et al. 2015 |
|
|
Study size, design and location |
569 people from 3 CCGs (see table 3) in the UK. |
|
Intervention and comparator(s) |
MEOMED compared with standard care. |
|
Key outcomes |
Using the MEOMED service, 78% fewer patients were referred to secondary care when compared to the standard pathway. A total of 37% of all patients – and 61% of all people with abnormal ECGs (256 from a total of 569) – had their condition managed in primary care, based on MEOMED's management plan. In the patients that the GP would have initially cared for in primary care, MEOMED recommended, within 2 hours, that 29% be referred to secondary care. In addition, 24 unnecessary referrals were prevented in a group of 30 patients that the GP would have referred to secondary care, based on patient history alone. A total of 5% of all patients were referred to secondary care by MEOMED, based on patient history alone. The average cost saving for a 60‑practice CCG was estimated to be:
|
|
Strengths and limitations |
The study included multiple practices across 3 CCGs. The report was written by employees of MEOMED in collaboration with Trustech (NHS Northwest innovation organisation). |