John Craig, CEO of Care City, explains how a new patient pathway – which uses NIA innovation, AliveCor Kardia – will find and treat atrial fibrillation, effectively saving lives and reducing costs. 

“Care City delivers no services, but today we launch an entire patient pathway. We don’t find people with atrial fibrillation (an irregular heartbeat that can cause stroke), or treat them, but our partners do; Barts Health, Waltham Forest CCG, Alivecor, North-East London Pharmaceutical Committee and Sonar Informatics. We have worked with them to develop an approach to finding and treating atrial fibrillation that can save lives, quickly and cost-effectively.

“Our approach uses Alivecor’s Kardia Mobile in community pharmacies to screen over-65s for AF with a 30-second test. Those who need further attention are referred directly to hospital, where the referral is reviewed by an expert, to prevent unnecessary appointments. Within two weeks, those who need treatment make one hospital visit at which the diagnosis can be confirmed and, if necessary, anti-coagulation initiated.”There are many benefits to the approach:

  • Screening around 1,300 people in Waltham Forest over six months will find new cases, and prevent strokes. In London, almost half of those with AF are unaware that they have the condition, or the five-times higher stroke risk associated with it.
  • Our independent evaluators – University College London – say that this pathway is cost-effective, and has the potential to prevent 1600-1700 strokes nationwide.
  • Streamlining the pathway will reduce time to treatment, from an average of 12 weeks nationally, down to two to three weeks.

“We are proud to launch this new pathway, and it is a helpful early example of Care City’s work as an NHS England Test Bed. The question for Test Beds nationally is: ‘how do you translate high-potential digital gadgets into better outcomes and experiences, and lower costs?’ There are three ideas behind our response to this challenge – we see digital implementation as creative, complex and combinatorial.

It’s creative, because while it is tempting for those championing a digital innovation to ask the NHS to ‘just get on and implement’, it is rarely that simple. Of the myriad of ways in which Kardia Mobile could be used, finding the best has taken creativity, testing and learning. That’s why Care City’s approach is to test rapidly, iterating with partners.

It’s complex, because health and care services are always messier in practice than in theory. To delight patients, change behaviour and make all the right resources and data go to the right place at the right time, innovators must be prepared for surprises and bumps in the road. That’s why our Test Bed focuses on ‘real world testing’ – putting innovations to work in core health and care services, not simulated or isolated research environments.

“And it’s combinatorial. That’s an odd word, perhaps, but it is what NHS England have asked Test Beds to do – to make innovations work by combining them with other innovations and services. That’s why Care City focuses on progressing from a technology to a detailed system blueprint, describing every step for every stakeholder to deliver better outcomes and experiences, and lower costs.”Another example of this approach – although at an earlier stage – is Care City’s work on gait analysis. We are working with Kinesis QTUG to use gait analysis to spot people at risk of falling – before they fall over – so that we can target falls prevention help on those who will most benefit. Again, we have applied this innovation within community pharmacy (David Brindle was right in the Guardian last week – the potential of pharmacy is vastly under-estimated). Customers who are over-65 are invited to wear clever sensors for a five-minute test, walking up and down the aisles, past the shampoo and the throat sweets, while the sensors compare their walk to thousands of others, so that those at significant risk can be referred directly for help.

“In Waltham Forest, that works well, because there is a strong falls prevention service waiting to help them. It turns out, this works less well in practice in Barking & Dagenham (B&D), because there just isn’t the capacity to help people who have not yet fallen over. The technology is great in theory, and works in some places. But to apply gait analysis to prevent falls in Barking & Dagenham would require us to get creative.

“We have worked with another gait analysis company – Gaitsmart – to do just that. This week, we will also begin further gait analysis in B&D, this time using the data not just to assess falls risk but to reduce it. A physiotherapist working off-site will use gait analysis data to create a personalised exercise plan describing, based on their walk, the exercises that will best protect and prolong patients’ mobility.

“This is the kind of work Care City exists to do, creating local benefit and national significance. To work in the way we describe, Care City always needs to do both. As with so many social enterprise, it’s about creating many kinds of value at once. As Liam Black, the first boss of the Fifteen Foundation said: “if we forget about great outcomes, we’re just another swanky restaurant. If we forget about great food, we’re just a community organisation with pasta.”

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