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The Oxford University-RAND Europe centre for rapid evaluation of technology-enabled remote monitoring: DECIDE (Digitally Enabled Care in Diverse Environments)

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A new centre will run rapid evaluations of technology-enabled remote monitoring—think blood pressure cuffs that send readings to a GP, or apps that track a patient’s symptoms from home—to find out whether these tools actually improve care, for whom, and at what cost. The problem is that health and social care systems are under pressure, and remote monitoring is being rolled out faster than the evidence to support it. There is little rigorous data on whether these technologies work, who benefits, and whether they widen or narrow inequalities. The DECIDE centre, a partnership between Oxford University and RAND Europe, will fill that gap by conducting fast, methodologically sound evaluations of real-world implementations. If successful, the centre’s findings will help commissioners and providers decide which remote monitoring services to adopt, scale up, or abandon. The work could shape how the NHS and social care systems invest in digital tools, potentially improving access for underserved groups while avoiding wasteful spending on ineffective technologies. A service user panel with diverse voices will help ensure the research reflects what patients actually need.

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Background: There is growing interest in technology-enabled health and social care, including in the use of remote monitoring. The aim is to respond to system pressures and improve access to, experience and quality of care. However, technology-enabled remote monitoring interventions are fairly new, with limited evidence about impact. There is an urgent need for process, outcome and impact evaluations of interventions at various stages of development and implementation to address questions around adoption, spread, sustainability and inequalities. Aim: NIHR will fund a 3-year team to conduct rapid evaluations in this field. Our proposed Oxford-RAND Europe centre for rapid evaluation of technology-enabled remote monitoring is known as DECIDE (Digitally Enabled Care in Diverse Environments). Through evaluative evidence generation and shared learning, it aims to support service users, service commissioners and providers of remote monitoring services, to enable high quality care. Patient and public involvement and engagement (PPIE): A Service User panel with diverse voices will help shape evaluation design, implementation and dissemination. This will include institutional members and – at project level - those with lived experience. We will work with our PPIE lead and wider team, who will also be supported by a steering committee of experts in health and care services, policy and service innovation. Approach and methods: DECIDE brings together expertise and a proven track record in health and care innovation- including adoption, spread and scale up, technology-enabled health and care, methodologically robust and rapid evaluations, prioritisation, co-production and stakeholder-engagement. Focused questions and evidence needs will emerge for each evaluation and be informed by established contributions to the theory and practice of understanding Non-Adoption, Abandonment and the challenges to Spread, Scale-up and Sustainability of technological innovation in health and care (NASSS framework). Specific evaluations will include set-up/scoping, main implementation and synthesis phases. Qualitative, quantitative and health economics methods will inform evaluations. Example questions are: • Is the technology-enabled remote monitoring innovation needed and if so, by whom? • How does it work and what factors relate to the intervention, implementation process and wider context influence adoption? • What are associated outcomes and impacts and on whom? • How does the intervention and its impacts mitigate and/or tackle inequalities and wider equality, diversity and inclusion considerations? • What are the opportunities and challenges for scale and spread? • What de-implementation considerations matter? Impact and dissemination: An overarching dissemination and impact strategy will be co-produced with steering committee and service-user input. Project led dissemination and impact and learning across evaluations (e.g. on topics, methods) will provide timely and rigorous insights to inform decision making by policymakers, commissioners, providers, patients/service-users and researchers. This involves: - formative and summative communications - tailored outputs to different audiences and contexts - at least one significant patient/public led output - a mix of written, visual, audio and verbal activities (e.g. journal outputs, policy briefs, webinars, case-vignettes, infographics, blogs, conference dissemination) - in-person and virtual engagements

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