Integrated Technology Ecosystem for ProACTive Patient Centred Care

THE CHALLENGE:

There are approximately 50 million patients in Europe with multimorbidity (two or more chronic health conditions) and 70-80% of healthcare costs are spent on management of chronic disease, at a cost of €700 billion per annum in the EU.

Most models of care focus on a single disease approach to treatment and care, which is not always adaptive to the needs of multimorbid patients as such there is a need to improve best practice around the 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.

THE SOLUTION: ProACT

ProACT is a citizen driven, self-management orientated, digital integrated care system capable of supporting multiple disease management and associated co-morbidities including well-being parameters (e.g. mobility and sleep) on a single user mobile application. The platform provides a unified approach to integrated care, centred on the person living with multimorbidity at home supported by key actors (informal caregivers, formal/social care workers, community-based clinicians, pharmacists and hospital-based clinicians).

For users ProACT collects and analyses data from individuals via the home-based health and well-being support kit (e.g. wearable and medical devices) and links them to their relevant care network support actors (e.g. family, caregivers, health professionals) via the suite of CareApps. The intelligent decision-making support from data collected between the persons managing their health and wellbeing and their support network increases the capacity to inform home based self-care by directing relevant information, support services and support actors to; improve the ability of individuals and services to understand from feedback data the best delivery of care; provide 24/7 real time feedback to individuals, key support actors and services; provide information on the individual at home and in the community.

Initially the system has been designed to target diabetes, heart disease, chronic heart failure and COPD; with the potential to be further developed post-project to address other chronic diseases across various age groups.

The system has been developed and successfully tested at a proof of concept (PoC) level with 144 persons with multimorbidity via an EU funded Horizon 2020 project ProACT (2016-2019), across 3 EU member states (Ireland, Belgium and Italy) with promising outcomes from trials, particularly in terms of user engagement and shift in behaviour to adopting a digital intervention. 166 key stakeholders (PwMs, GPs, Pharmacists, Caregivers, Hospital Consultants) across these countries were also involved in the platform co-design and development process and Irish TILDA data-sets (https://tilda.tcd.ie) representing 9000 older Irish adults have been used to train the system artificial intelligence on the key ProACT diseases (diabetes, chronic obstructive pulmonary disease (COPD), chronic heart (CHD) disease, chronic heart failure (CHF)).

Outcomes from ProACT to date have been significant (including 31 journal/conference papers, 6 published abstracts, 56 conference presentations, 16 hosted events at conference/workshop, 9 trial seminar etc) and have been widely disseminated at international level.

Seven innovations also developed as part of the platform were identified by European Commission experts for inclusion in the EU Innovation Radar Prize. The system also received a commendation from the Irish Healthcare Awards 2018 and was a finalist in the 2019 European Data Science Awards.

Post project work on ProACT will continue as to date 7 associated competitive grant awards have been secured to advance the ProACT platform and associated research, with further trials due to commence in early 2020.

Finally, the ProACT team is currently advancing a ProACT spin-off company (to be launched in 2020) using the collective outputs of the Horizon 2020 project parallel to the on-going research activity.

ProACT has significantly advanced EU understanding of people centre digital integrated care for persons living with multiple chronic diseases. This is an area previously under-explored within EU health systems. Project outcomes provide insight into how ProACT could help advance a new digital integrated care system that is flexible to health system demands, affordable and people-centric.

The platform has been systematically designed and evaluated as a behaviour change intervention to improve self-management skills for the PwM. Three behavioural targets were designed into the system to be both measurable and impactful. Overall trial results indicate the behavioural targets and approaches taken in ProACT (e.g. in terms of the intervention design) were successful with trial participants effectively changing their behaviours in terms of moving from paper-based or ad hoc strategies to using a digital tool to self-manage over the 12-month trial. A new framework for the design and development of a Digital Health Behavioural Change Intervention was developed in the project and will be published in 2020.

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 digital technologies to improve home based management/care of multimorbidity, adding potential value to international guidelines (e.g. NICE Guidelines on Multimorbidity).

Overall key trial outputs of note include:

• Self-management, health literacy and health self-awareness improved for the majority of PwMs
• PwMs reported fewer symptom alerts over time, as PwMs learned to better manage their symptoms
• PwMs became the coordinators of their own care – they had more knowledge and awareness of conditions and were more confident to discuss their health and wellbeing, and the health supports they wanted, with their HCPs as a result of participation.
• Improved health and wellbeing were reported by PwMs, especially improved diet, increased physical activity and better mood.
• Caregivers and healthcare professions positively engaged with ProACT endorsing it’s flexible approach to integrated care (e.g. they can monitor via their own tailored CareApp and/or view outputs on/from the PwM app and/or be alerted when a person presented health risk by the clinical triage service which was provided)

Finally, ProACT developed a new explanatory model for the transferability of digital solutions supporting integrated care. The knowledge provided through this model identifies positive and negative factors which contribute to the transferability of digital platforms such as ProACT and, therefore provides clear guidelines to optimise the transferability potential of digital platforms supporting integrated care from a European region/country to another. This will also be published in 2020.

Periodic Reporting for period 3 - ProACT (Integrated Technology Ecosystem for ProACTive Patient Centred Care)

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