Assessment of

Background and aim

In connection with the project “National implementation of telemedical ulcer monitoring”, an assessment that investigates the effects of telemedical ulcer monitoring and the electronic ulcer record (“pleje.net”) has been performed. The assessment has focused on patients with venous leg ulcers and diabetic foot ulcers, which are treated across sectors (municipalities and hospitals) around the Danish regions.

The Model for Assessment of Telemedicine (MAST), a European model developed specifically for the evaluation of telemedicine solutions, has been used as a framework for the assessment. The assessment has been produced by CIMT, funded by the Public Welfare Technology Fund, and published by Medcom, Local Government Denmark, Danish Regions, the Agency for Digitisation and the Ministry of Health.

Methods

Among others, the assessment is based on results from a research project in Region of Southern Denmark, and assessments of the patient perspective from the Capital Region of Denmark. In addition, the assessment is based on data from the ulcer record as well as interviews (35 participants) and a questionnaire survey (418 respondents) with staff from municipalities and hospitals as well as regional project managers from across the country.

Results
Domain 1: Health Problem and Technology

Telemedical ulcer monitoring is a two-part intervention, i.e. partly consisting of an electronic ulcer record (‘pleje.net’), which is used as a documentation tool and for telemedical communication between healthcare professionals, and partly an organizational intervention in the form of changes in collaboration, workflows and competence development across sectors.

Analysis of data from ‘pleje.net’ shows that telemedical ulcer monitoring is implemented in all regions. The activity is highest in the Capital Region of Denmark, Central Denmark Region and North Denmark Region, which all have reached the project goal of a deployment rate of 27%.

Domain 2: Safety

‘Pleje.net’ a reliable system with an uptime close to 100% in the project period.

Domain 3: Clinical Effectiveness – Results from other projects in Denmark

Before and concurrently with the project “National implementation of Telemedical ulcer monitoring”, Region of Southern Denmark and Region Zealand have conducted studies of telemedical ulcer monitoring. These studies are not part of the national project, but similar to the national project on several points; i.a. having the same purpose and using the same technical application (‘pleje.net’). The study from Region Zealand found a statistically significant improvement in wound healing among patients in the telemedical group, while the results from the research project in Region of Southern Denmark shows no difference in wound healing and number of amputation, suggesting that telemedical ulcer monitoring is similar to standard monitoring. However, the study found a statistically significant higher mortality among patients in the telemedical group. However, a causal relationship to explain the increased mortality could not be established and it should be noted that the group of patients is very complex, and characterized by multimorbidity. Following a notification of the results from the research project in Southern Denmark, precautionary actions were taken in the national project. By comparing the results from these research projects and the project “National implementation of telemedical ulcer monitoring” it should be noted that the projects differ on several points, including the organizational setup about telemedical ulcer monitoring and competence development. In addition, the routines of the staff may not be completely comparable, since the use of telemedicine ulcer monitoring have been much less deployed in Region of Southern Denmark and Region Zealand compared to the Capital Region of Demark, Central Denmark Region and North Denmark Region.

Domain 4: Patient Perspectives

The available studies on patient satisfaction from the Capital Region of Denmark show that patients have a high degree of satisfaction due to improved cooperation between hospitals and municipalities. Furthermore, they are happy to save time due to fewer outpatient visits at the hospital.

Domain 5: Economic aspects – Results from other projects in Denmark

As part of “National implementation of telemedical ulcer monitoring” a recalculation of the original business case has been carried out. However, in the time of writing, these results have not been published. Therefore, results from the economic analysis performed in the research project in Southern Denmark are presented in this assessment. This shows that the average cost per patient is lower in the telemedical group compared to the control group. However, this is not statistically significant, and reservations mentioned in domain 3 are also evident in this domain when comparing the research project in Southern Denmark and the national project.

Domain 6: Organisational aspects

In general, the respondents believe that the project has led to an improvement in their wound care skills, especially among the nurses from municipalities. It also appears that the cooperation and communication between municipalities and hospitals have improved. ‘Pleje.net’ has led to better, more consistent and systematic documentation, but it has also resulted in increased double registration.

The respondents indicate that they have experienced challenges in the implementation, and are asking for better management and governance at the national level. In general, participants in interviews would like to continue working with telemedical ulcer monitoring.

Conclusion

The assessment shows a number of positive effects, especially in regards to improved level of competence and cooperation. In this assessment, the clinical and economic effects of the project “National implementation of telemedical ulcer monitoring” cannot be documented. The assessment is mainly based on interviews and a survey with staff from hospitals and municipalities. Therefore, it contains many broad and qualitative results and few quantitative results. Thus, there is a need for more studies to document the clinical and economic effects of the national project.

Due to great differences in the organisational setup it is problematic to talk about general nationwide effects. The project is the first of its kind at the national level in Denmark, and it has i.a. illustrated the challenges that have been associated with the implementation of telemedical ulcer monitoring, but also organisational advantages of telemedical ulcer monitoring, including better cooperation and communication between staff from municipalities and hospitals.

The final MAST report and appendixes are available here (in Danish).

For further information about the assessment, please contact:

Mette Bøg Horup

Mobil: +45 24460772

E-mail: mette.bog@rsyd.dk

Permanent link to this article: http://old.cimt.dk/projects/htaandevaluation/assessment-ulcer-monitoring/