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IntroductionAssessing the cost utility of health technologies for pediatric patients requires robust utility values for child health states, but the methods for valuing these pediatric health states are much less established than those for valuing adult health states. This is partly because the elicitation of preferences for child health states poses many normative, ethical, and practical challenges.MethodsThis presentation examines the conceptual issues in the valuation of health states in children by addressing the following questions.(i)Normative theories of health state values: What are we attempting to elicit?(ii)Sources of preferences: Whose preferences should we elicit, and from which perspective?(iii)Valuation methodologies: How should we elicit preferences?(iv)Attaching different values to child and adult health: Is a lack of consistency problematic?To answer these questions, we used desk research (non-systematic literature reviews) and findings from a two-part workshop held in April 2021. The workshop included 25 participants with expertise in health economics, health state valuation, child health, health technology assessment (HTA) decision-making, and ethics.ResultsWe identified a lack of consensus on what is being elicited for both adults and children. Many HTA agencies recommend that the public be involved in utility generation exercises, but some criteria for defining who constitutes a member of the public exclude children. Of the many candidate sample types, perspectives, and methodologies, only a few were deemed relevant, acceptable, and feasible for use in the child health context. In addition, there were diverging views on whether it is possible to compare and integrate adult and child value sets with different properties.ConclusionsSeveral questions remain to be answered before the public and other stakeholders can have confidence in child health state valuation protocols. We propose a research agenda, including both empirical and conceptual work, to inform future methodological development and to help HTA agencies make recommendations about how child utility values should be generated.

Background Depending on the treatment to be investigated, a clinical trial could be designed to assess objectives of superiority, equivalence or non-inferiority. The design of the study is affected by many different elements including the control treatment, the primary outcome and associated relationships. In some studies, there could be more than one outcome of interest. In these situations, benefit-risk methodologies could be used to assess the outcomes simultaneously and consider the trade-off between the benefits against the risks of a treatment. Benefit-risk is used within the regulatory industry but seldom included within publicly funded clinical trials within the UK. This project aims to gain an expert consensus on how to select the appropriate trial design (e.g. superiority) and when to consider including benefit-risk methods. Methods The project will consist of four work packages: A web-based survey to elicit current experiences and opinions, A rapid literature review to assess any current recommendations, A two-day consensus workshop to gain agreement on the recommendations, and Production of a guidance document. Discussion The aim of the project is to provide a guideline for clinical researchers, grant funding bodies and reviewers for grant bodies for how to select the most appropriate trial design and when it is appropriate to consider using benefit-risk methods. The focus of the guideline will be on publicly funded trials however, the vision is that the work will be applicable across research settings and we will connect with other organisations and committees as appropriate.

Policy makers in the UK are looking to technology such as telehealth as a solution to the increasing\ud demand for long term health care. Telehealth uses digital home monitoring devices and mobile\ud applications to measure vital signs and symptoms that health professionals interpret remotely. The\ud take up of telehealth in community health care is slow because there is uncertainty about its use.\ud Findings from a qualitative study of community healthcare show that community nurses are managing\ud uncertainty through a complex set of negotiations. Drawing on Strauss’ concept of negotiated order\ud the study found three key areas of negotiation, which are ‘supported care interdependencies’, ‘nursingpatient relationships’, and ‘risk management’. The relational, communicative and collaborative working\ud practices of nurses shape these areas of negotiation and the resulting negotiated order. This article\ud focuses on the perspectives of nurses in negotiating telehealth with their patients.

Telehealth is used to help people manage their heath and maintain independence, but has proved difficult to integrate into routine practice.To explore the barriers to telehealth and find out what helps to improve its adoption among nursing staff.Case studies were compiled from four community health services in the Yorkshire and Humber region that were using telehealth to monitor patients. The case studies used interviews with 84 community nursing, technical and support staff, and 21 managers. Some 40 telehealth users and 12 carers were also interviewed.Factors serving as barriers to the use of telehealth, including lack of planning, insufficient training, lack of time and technological problems. Factors encouraging uptake included giving nurses time to experiment with the technology, a clear service pathway, establishing telehealth champions to troubleshoot and disseminate information, and successful care using telehealth.Factors improving the adoption of telehealth in community nursing include: better planning of how the service operates and installing appropriate technology, good communication with nurses and service users, establishing telehealth champions and providing ongoing training and support.Many of the barriers in using telehealth can be avoided with better planning and collaboration.

Background: The successful mainstreaming of assisted living technologies remains an important policy and commercial concern within the UK. Despite this, local telehealth services have not developed at the pace and scale anticipated. This project, funded by the Technology Strategy Board through the Assisted Living Innovation Platform, aims to understand and seeks ways to overcome the financial, organisational and operational barriers to mainstreaming telehealth. Aim: To highlight and reflect on the methodological and practical issues in conducting participatory research in collaboration with telehealth services. Methods: Within the MALT study, a multi-disciplinary consortium of research organisations are collaborating with telehealth services in four specific sites in the Yorkshire and Humber region. The research is composed of two phases: phase 1 involves producing detailed qualitative case studies to identify barriers and facilitators to successful delivery of telehealth, with a view to developing ‘change projects’; the implementation and delivery of which will be explored through action research in phase 2. Results: The role of the research team in participatory action research is one of partnership and collaboration. However, there is a consultative element to projects of this nature, as the researchers work alongside stakeholders using the findings from phase 1 to inform the telehealth change projects to initiate and evaluate in phase 2. While participatory research methods are useful for understanding and evaluating change, this partnership approach blurs the role of researchers, who may be seen as imposing change by encouraging sites to look at ways to expand or improve their existing service at a time when cost effectiveness and patient benefit remain unclear. The pace of development regarding the wider use of assisted living technologies also has implications for this research project, given the growing consensus that telehealth should form only one part of a wider menu of digital options that clinicians use with their patients to promote selfmanagement. This broad approach to technology adoption underpins the Department of Health’s 3 Million Lives initiative, which can also be seen as an additional top down pressure at the local level International Congress on Telehealth and Telecare 2013, London, July 01-03, 2013. 2 International Journal of Integrated Care –Volume 13, 20 November –URN:NBN:NL:UI:10-1-115704– http://www.ijic.org/ to drive forward adoption and upscaling. This makes for complex, yet interesting, case studies within a context of wider structural and commissioning changes for NHS primary care, and equivocal evidence on the effectiveness of telehealth. Conclusion: The MALT study highlights the complexity of telehealth service re-design and the importance of the shifting policy emphasis and technological advancements. Crucially, as local services respond to these developments, the changes can be reactive and organic, and difficult to capture as the research moves forward. It is therefore crucial for the research team to maintain close and regular contact with participants to ensure the ongoing relevance of data collection, analysis and recommendations, and to manage the sometimes competing expectations for the research among different stakeholders. Maintaining this relationship is an integral aspect of the research, however the blurring of researcher roles requires careful reflection on both the extent of and limits to the role played in service development.

Background: The future large-scale deployment of Assisted Living Technologies crucially depends on establishing patient benefit at scale. This entails overcoming barriers to uptake, and devising viable service and business models. This current project, MALT: Overcoming Barriers to Mainstreaming Assisted Living Technologies, funded by the Technology Strategy Board through the Assisted Living Innovation Platform, aims to explore these issues with a focus on the delivery of telehealth for people with chronic obstructive pulmonary disease and chronic heart failure. Aim: To explore the barriers and facilitators to telehealth across four sites currently delivering community based services in the Yorkshire and Humber region. In particular, this paper focuses on the perceptions and roles of frontline staff at the implementation and delivery phases of telehealth, which are identified as both potential barriers and facilitators to mainstreaming telehealth successfully. Methods: This first phase of the study involved qualitative interviews with samples of frontline nursing staff; managers, commissioners and other key stakeholders; and patients and carers from each site. Drawing on the existing literature, the data were analysed thematically to identify the barriers and facilitators to successful telehealth implementation and delivery. Results: Staff views of telehealth as a new tool for practice range from resistance and scepticism, to acceptance and enthusiasm, and there are varying opinions about the overall rationale for using telehealth in the community and the patient groups most likely to benefit. Where initial perceptions about telehealth are negative and the availability of training, support and encouragement limited, acceptance of telehealth among frontline staff can be low. Staff engagement at the implementation phase is also influenced by other factors such as workload and working practices; rapid organisational change; and existing information systems and technology. ‘Local champions’ who promote, encourage and support staff, and share their positive experiences of using telehealth can help to counteract these barriers and persuade staff to introduce telehealth for their patients. Other facilitators were also found to be important, including clear and robust systems for installation, technical support and patient monitoring; and user-friendly and appropriate equipment. International Congress on Telehealth and Telecare 2013, London, July 01-03, 2013. 2 International Journal of Integrated Care –Volume 13, 20 November –URN:NBN:NL:UI:10-1-115694– http://www.ijic.org/ Conclusions: Effective service implementation hinges on the acceptance of frontline staff who assume responsibility for promoting the use of telehealth; selecting and referring patients for telehealth; installing and maintaining telehealth equipment; monitoring patients and managing alerts; supporting users of telehealth and meeting their health and related needs; and case managing patients. For some staff telehealth is only one aspect of their wider role, and where perceptions are initially negative, sharing positive stories about using telehealth can encourage staff to challenge these views and learn more about the potential benefits of using telehealth, both for their patients and themselves. However, sharing best practice can be difficult at the implementation phase due to the range of services and staff groups involved in delivering telehealth, and because success stories are not always immediately available.