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Evaluations of service innovations such as telehealth need to assess the effect from the patient’s perspective, using self report measures such as quality of life (Qo L), psychological outcomes, and acceptability of services.

This approach is in line with the developing agenda on patient reported outcomes,13 14 15 16 17 and complements more familiar outcomes such as service use, costs, and mortality.

Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth usual care) was non-significant for any outcome (complete case cohort 0.273≤P≤0.761; available case cohort 0.145≤P≤0.696).Conclusions Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only.General practice was the unit of randomisation, and telehealth was compared with usual care.Data were collected at baseline, four months (short term), and 12 months (long term).Secondary per protocol analyses tested treatment efficacy and included 6 participants in the complete case and available case cohorts, respectively.

Setting Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems.Participants Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009.Main outcome measures Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale).In the present study, we focus on the WSD telehealth questionnaire study and report on the effect of telehealth on health related Qo L and two psychological outcomes (anxiety and depressive symptoms).For this part of the WSD Evaluation, we assessed the hypothesis that introduction of a broad class of home based telehealth improves quality of life, anxiety, and depressive symptoms over a 12 month period for patients with chronic obstructive pulmonary disease, diabetes, or heart failure, compared with usual care only.They showed ambivalent evidence; half the studies suggested a significant positive effect on health related Qo L, and the other half showed no effect.42 43One systematic review has investigated the effect of telehealth on health related Qo L in diabetes.44 This review confounds two patient reported outcomes with different meanings: health related Qo L and patient satisfaction.