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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - ProACT (Integrated Technology Ecosystem for ProACTive Patient Centred Care)

Teaser

Summary

ProACT (Integrated Technology Ecosystems for ProACTtive Patient Centred Care) aims to develop and evaluate a digital integrated care system to support older adults (aged 65+) with multimorbidity.

The Problem/Challenge
There are approximately 50 million patients in Europe with multimorbidity (two or more chronic health conditions).

70-80% of healthcare costs are spent on management of chronic disease, at a cost of â‚¬700 billion per annum in the EU.

Most models of care across the EU focus on a single disease approach to treatment and care, which is not always adaptive to the needs of multimorbid patients.

Care for the person with multimorbidity (PwM) is frequently repetitive, inconvenient, inefficient, confusing, burdensome, and potentially unsafe due to poorly integrated and coordinated care. This has a range of negative consequences - for the health and quality of life of PwMs and their carers, and at a wider societal level due to burden placed on healthcare systems.

There is a need to improve best practice around provision of well-coordinated, person-centred care for multimorbidity, and to empower patients and their caregivers to play an active role in self-management and care practices.

A Potential Solution: ProACT

ProACT will develop and evaluate a digital integrated care system to help coordinate and support multimorbid disease management, including self-management. A behaviour change framework will be incorporated into the overall design, to support sustainability and scalability of the ProACT system.

ProACT aims to provide a unified approach to integrated care, centred on the PwM at home supported by key actors (informal caregivers, formal/social care workers, community based clinicians, pharmacists and hospital based clinicians).

Initially the system will be designed to target diabetes, CHF/CHD, COPD and MCI; with the potential to be further developed post-project to address other chronic diseases across various age groups.

A range of new and existing care applications, sensors and healthcare technology devices will be linked to the ProACT system. Customised interfaces will allow PwMs and their key support actors to access the system via their tablet, smartphone or computer, to input and access relevant information to support home-based, digital, integrated healthcare.

ProACT will aggregate health and wellbeing data, and support users in learning from and using this data to support self-management of their conditions. This will include: symptom data (e.g. weight, blood pressure, blood glucose), activity data (e.g. step count, sleep), social connectedness and medication management data.

The project will take place across two primary trial sites in Ireland and Belgium, and a third transfer trial site in Italy.

Work performed

Desk research and stakeholder interviews were conducted to map current care pathways (for both ProACT single state diseases and multimorbidity) across care environments in each ProACT trial site and to complete a detailed stakeholder mapping exercise.

Qualitative and quantitative data were collected from 166 participants (PwMs, informal carers, formal carers and health and social care professionals) for a user requirements study. A set of 47 key requirements were identified, which will be used to define the functionality of the system. A public whitepaper was produced to summarise the outputs of this study.

The process of translating user requirements into functional and technical requirements, and development of initial prototypes, is underway. This work will be informed by ongoing user-centred design workshops.

Extensive scoping exercises and lab testing of devices were conducted to identify technologies for inclusion in ProACT and for testing in the friendly trial phase; protocols for deployment of these technologies were developed.

The preliminary system architecture for ProACT was designed, and development of core components of the ProACT system has commenced; the first release of the system has been deployed in each trial site for pilot testing.

Extensive desk research and consensus meetings have been conducted to inform development of a behaviour change framework to support adoption of ProACT.

Desk research was conducted to compile an initial ProACT competitive market analysis, which will be further developed as the project progresses and the ProACT system offering is refined.

Reports were developed outlining the legal, ethical, regulatory and data protection issues/requirements relevant to this stage of the project. Roadmaps have been put in place to plan for future progression of these areas moving into the friendly trial and main PoC trial.

A Dissemination, Exploitation and Communication Strategy was produced; this strategy is being implemented on an ongoing basis. This includes set-up of a ProACT website, social media and digital dissemination tools, activities to support wider communication objectives, and activities directed at dissemination of project results.

Final results

The area of multimorbidity self-management and care is under-explored within EU health systems. ProACT has significantly advanced understanding in this area by engaging with key stakeholders (n=166) across three member states to collect rich, multi-stakeholder, qualitative data about needs and requirements for multimorbidity management. Outcomes are being used to progress understanding of how best to design and develop a digital system to support integration of care and self-management for multimorbidity.

The systematic application of behavioural change theory as part of the design of a digital integrated care system for multimorbidity is novel to ProACT. This approach aims to enhance system engagement and adoption.

The use of cognitive computing within ProACT InterACT (created by partner IBM -WP3) will seek to improve understanding about how best to direct patient self-management linked to support from key actors as part of an effective workflow management model.

Outcomes from WP1 & 4 are being used to inform best practices for optimising service and care delivery for PwMs, by linking data from different organisational structures and healthcare teams. ProACT will further enhance societal impact by providing training applications linked to system use for both patients and key support actors in their care network. Development of these training applications has been informed directly by research conducted in WP1, 2 & 4.

Outcomes from WP1 have also provided new insights into how ProACT could help to advance new healthcare models that are flexible, affordable and patient-centric. Key to this flexibility is two factors; (1) future proofing device selection: ProACT has endeavoured to ensure that technology selected is state of the art and current in terms of future relevance to the health self-management market; (2) System openness: With ProACT having an open API the integration of future devices is possible. This is critical for future societal impact, given the variety of possible future devices that will be developed and on the market post-project.

Overall ProACT is actively challenging single disease frameworks of care to advance home-based care for PwMs. Our co-design and patient centric approach has allowed for greater understanding of the use of ICT-AT to improve community based management and care of multimorbidity adding potential value to international guidelines (e.g. NICE Guidelines on Multimorbidity).