We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.

Abstract'Telecare' is the use of information and communication technology to facilitate health and social care delivery to individuals in their own homes. Governments around the world are seeking to introduce telecare partly to help address the challenges posed by an ageing society. Telecare is inherently complex to implement and operate because it involves combination of technological and organisational innovation in an environment of diverse stakeholders.Using research on two telecare schemes in the UK, the paper explores the way project complexity, organisational context and project management approach interacted during the planning and implementation phases. The paper discusses how insights from research in related areas, including medical technology and service sector innovation in general, could help to explain why From: Technovation (forthcoming) NOT TO BE QUOTED WITHOUT PERMISSION 2 mainstream telecare delivery has been difficult and draws conclusions on the role of project management in the implementation of innovation.

The provision of health and social care for an increasing elderly population is a challenge facing many societies. Telecare, the delivery of health and social care to individuals within the home or wider community, with the support of information and communication technologies, has been advocated as an approach to reduce the rise in the number of elderly people in institutional care and to contain costs. A dynamic model is required to understand the systemic impact of telecare implementation over time. The paper cautions against overoptimistic expectations about the impact of telecare in the short term and emphasises that the benefits for healthcare systems may take a considerable time to be realised.

Telecare' involves the use of information and communications technologies to provide support for vulnerable individuals living in the community. The UK government wishes to make telecare available in all homes that need it by 2010. This expansion is seen as central to the improvement of older people's independence and quality of life by enabling them to live at home whenever possible. The paper discusses the range of initiatives now in place to facilitate the introduction of telecare in the UK. It argues that while there is now experience of telecare through pilot and demonstration schemes, moving to mainstream service delivery is far from straightforward. Using a case study of a telecare scheme, along with supplementary data from other schemes, the paper explores the reasons why it may be hard to meet government objectives. These include the organisational and cultural characteristics of local care institutions and the complexity of scheme objectives. It draws conclusions on the challenges in meeting aspirations for mass telecare over the next decade and on the future role of the housing stock in care provision.

The UK government wishes to deploy a mainstream telecare service by 2010. We believe that it will be necessary to overcome the organizational and structural barriers to such an implementation. A better understanding of the effect of telecare across the care system as a whole will also be needed. In the absence of rigorous data from trials and because of the time taken for systemic effects to emerge, the evidence for the benefits of telecare needs to be explored through simulation modelling.