Community Research and Development Information Service - CORDIS


DECI Report Summary

Project ID: 643588
Funded under: H2020-EU.3.1.

Periodic Reporting for period 1 - DECI (Digital Environment for Cognitive Inclusion)

Reporting period: 2015-06-01 to 2016-05-31

Summary of the context and overall objectives of the project

The progressive increase in the average human lifespan generates a rising importance of problems and issues related to ageing: these include cognitive impairment such as loss of memory, cognitive slow down, aphasia, apraxia, sensorial and movement deficit, personality and mood disorders. Cognitive impairment reduces the ability of taking care of themselves and the risk of social isolation, institutionalization and mortality. The elderly with mild to moderate cognitive limits, especially when living in solitude, are significantly exposed to undeniable risks for their own safety: falling, malnutrition or unhealthy nutrition - possibly due to poverty - hygiene issues due to lack of mobility, isolation and depression; all can affect their health.
In this context, the goal of the project is to define an innovative business model to supply assistance services (in-house for the elderly and with a remote-based approach supporting autonomy), allowing independent living for elderly people, especially for those affected by mild to moderate dementia or mild Cognitive Impairment, granting high levels of quality of life. The proposed business model will include an up-to-date, modular, flexible and scalable organisational model, meant for both regulators and service suppliers, and the support of a comprehensive digital environment platform based on innovative and easy-to-replicate digital solutions. These elements will be inserted and integrated inside patients’ homes: the core focus of the project will revolve around assistance towards mild to moderate Cognitive Impairment-affected individuals inside their houses. The challenge of this proposition is to address the assisted and independent living service delivery ensuring effectiveness, usability and sustainability on three main levels:
• Alignment and coherence between processes, organisational model key stakeholders, and enabling technologies in different application contexts (four different countries): Israel, Italy, Spain and Sweden;
• Technical usability and user acceptance, essential when dealing with technologically advanced systems, as these must not be perceived as excessively invasive by end users;
• Economically sustainable business models, in order to deliver services with a new, innovative approach, and coherently to different (national, public and private) health service systems.
To reach these goals, a team of experts with different backgrounds and competences (researchers, tele-assistance and tele-monitoring experts, physicians, etc., and also caregivers, proximity networks, support networks) will be assembled. This is an opportunity to approach, within a single project, three core leverages to increase MCI-affected elderly quality of life through a comprehensive integrated solution:
• Organisational model and processes. The organization to deliver assistance services to elderly people effected by mild Cognitive Impairments, especially if living in solitude, will surpass traditional care methods aiming for a more affective, personalized and farsighted approach. The aim is to increase quality of life of patients, while simultaneously meeting organisational and economic goals. A radical rethinking of organisational models and processes is not only possible, but in this case is mandatory to increase patients’ quality of life, satisfaction and, in general, happiness.
• Digital technologies. The resulting output will be designed to support daily activities of the elderly people affected by mild Cognitive Impairment, by remotely monitor patients’ conditions in order to effectively support the delivery of personalized services. On the one hand, this requires the definition of relevant data that need to be traced, approaches and tools for data registration and both semantics and syntactic standard to ensure complete interoperability and fruition of relevant information. On the other, the project needs policies and rules for data flows exchange among network nodes. The technology platform will be developed by integrating the most innovative, yet accessible technologies (such as monitoring sensors, Internet of Things paradigms and application mash-ups aiming to support development and composition of new services and new Human-Computer Interaction paradigms, etc.) and will be based on information sharing, data interoperability and modularity logics, which will also be replicable inside different organisational contexts.
• Business plan and economic models. For each different application area, in private or public sectors and in different countries, economic feasibility studies will be performed in order to address cost coverage issues related to the implementation of new procedures and technological solutions. The economic portion of the business plan will take into account both service delivery re-organization costs and enabling technologies costs. With regards to the four pilots scheduled in the project proposal, each economic model (for the different application area) will include a final evaluation of implementation costs and benefits and an analysis of return on investment.
Four different master plans will start in four different countries: Israel, Italy, Spain and Sweden. Every project will pass through the implementation of the proposed organisational model and the digital solution defined as part of the project, therefore allowing a simplified and effective tuning of both the model and the related digital tools. Then the validation of the solution in each real-life environment will enable the analysis of related evidence to validate the economic sustainability of the proposed business plan. Both implementation and analysis will be led inside patients’ domestic environment, focusing on indoor living from any relevant perspective affecting—directly or indirectly—patients’ quality of life.
DECI will focus on how developing a reshaped overview of holistic socio-care services, and will study the mechanism through which integrate and harmonize the organisation and delivery of health and social care services. Today, it is very expensive to receive socio-care services from highly trained professionals. Without the largesse of well-heeled employers and governments that are willing to pay for much of it, most solutions for independent living are inaccessible to most of elderly people. Three elements seem to have the potential—if well and coherently designed (Christensen et al., 2009)—of making these services affordable and effective:
1. Enabling Digital Environment
2. Business Model Innovation
3. Mutually Reinforcing Value Network
These elements represent the pillars on which DECI project has been designed. In the middle of these pillars are of course a host of regulatory reforms and new industry standards that EU commission has to develop to facilitate the interactions among the participants in the disrupted socio-care industry. From this viewpoint, DECI can constitute a first important empirical setting in which start developing these regulations and standards.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

The Year 1 of the DECI (Digital Environment for Cognitive Inclusion) project was mainly focused on the following researching activities, executed within WP1, WP2 and WP3:
1. Analysis of the state-of-the art in a number of fields related to project topics: clinical literature on Mild Cognitive Impairment (MCI) and Dementia, organizational models for care and assistance to patients affected by MCI or Dementia, digital technologies for improving process support to care and assistance, case studies on innovative organizational models and advanced implementation of digital technologies to improve inclusion, cognitive stimulation, process support;
2. Deep field analysis of the state-of-the-art of the clinical population, care and assistance processes, organizational models, use of digital technologies in the four specific settings of DECI pilot sites (Italy, Spain, Sweden, Israel);
3. Analysis and design of the DECI Business Model (BM) to exploit digital technologies for improving cognitive support and inclusion of patients affected by MCI or Dementia;
4. Analysis and drafting of DECI pilot scenarios and DECI digital platform services, that will be implemented at the above-mentioned four pilot sites to validate the BM design and evaluate its potential impact on the care ecosystem.
In particular, in the first part of the Year 1, the Consortium focused, from a clinical perspective, on the analysis of the state-of-art and best practices for managing patients with cognitive impairment, and on the definition of the cluster of patients to be used in the rest of the project, within WP1 (T1.1 and T1.2).
From a technological perspective, instead, the Consortium focused on the benchmarking of the digital solutions used for assisting elderly people with cognitive impairments, within WP2 (T2.1). The analysis accomplished during WP2 has been also focused onto the BMs related to the digital solutions used for DECI patients (T2.2).
In the second part of the Year 1, the Consortium focused on designing the BM through which improving cognitive support and inclusion of patients affected by MCI or Dementia, and on its specialization through the designing of specific DECI scenarios and digital services for each piloting site.
The analysis performed during the first part of the Year 1 confirmed the need of a bilateral approach to achieve these goals. On the one hand, it is necessary to define the DECI BM starting from a consolidated literature analysis. On the other hand, the definition of DECI scenarios can be performed only thanks to the contribution of stakeholders directly involved in the care process for people with MCI and mild dementia. Given a restricted time to perform the focal activity of scenarios design, the Consortium decided to follow a parallel double-tier perspective:
1. A top-down design process of the DECI BM, fed by theoretical and empirical analysis performed on all topics within WP1 and WP2;
2. A bottom-up design process of pilot scenarios, deeply participative for stakeholders within and external to DECI partners’ organizations (Local Brainstorming Sessions – LBSs), also fed by benchmark analysis of similar projects and field-study of processes, organizations, clinical needs and information systems at each local site (outputs of WP1 and WP2).
The two perspectives have been run in parallel, but are heavily intertwined, thanks to a strong link between local-based activities and theoretical modelling. These two design processes, indeed, should generate aligned results in order to demonstrate that the business models created from top-down perspective correctly meet the real local requirements emerged from the bottom-up perspective.
All discussions will provide inputs to:
• Task 1.3: pilot project parameters and pilot scenarios (D1.5);
• Task 3.1: BMs for delivery of assistance and independent living services (D3.1);
• Task 2.4: feasibility check of the BMs (D1.3) and of the drafted pilot scenarios (D1.5);
• Task 3.2: home care process models in each pilot site (D3.1 and D3.2);

The figure “Top-down and bottom-up perspectives” - attached to this summary - depicts the rationale of the two perspectives.

We reported the main achievements at WP level.

WP1 - Analysis of needs and existing models to manage elderly people with cognitive impairment
• D1.1. “State-of-the-art of clinical and assistance management models and practices of elderly patients with MCI”
• D1.2. “Patient clusters”
• D1.3. “Patients, caregivers; and support and clinical organisational needs”
• D1.4. “Key performance indicator to be monitored (clinical management)”
• D1.5. “Design of the final pilot based on the pre pilot study”

WP2 – BMs and ICT solutions for digital services
• D2.1 “Benchmarking of the digital solutions used for assisting elderly people with cognitive impairments”
• D2.2 “Business model of the digital solutions used for assisting elderly people with cognitive impairments”
• D2.3 “Change management and introduction processes of the digital solutions used for assisting elderly people with cognitive impairments”

WP3 – Design of the Digital Environment for Cognitive Inclusion
• Design of the Business Model specified for each pilot site
• Design of TO-BE organizational and process models specified for each pilot site

Delivered in D3.1 “Business models and processes with details on procedure for carrying out the various activities and identification of areas for the introduction of IT solutions”

• Mapping of the DECI functionalities, emerged within DECI scenarios defined trough LBSs, on macro-phases of the designed home care process
• The methodology to gather functional and not functional requirement has been defined with use case diagram
• Launching of the ICT solutions requirements analysis
• A preliminary version of the overall application layer architecture has been discussed with all partners
• Interfaces towards external existing systems have been defined

Delivered in the first draft of D3.2 “Document of ICT solution requirements analysis”

WP4 – Tools and solutions implementation to support the Digital Environment
• Customization of wearable devices, accordingly to the shared requirements and project specifications have been performed. All technical partners have shared the architecture of the modules of their own responsibility
• Preliminary version of communication interfaces for the DECI system

WP5 – Pilots setting, organizational and technological model tuning & validation
WP yet to be started.

WP6 – Evaluation of business, industrial and quality impacts
Gathered profound knowledge of principles in evaluation in general. A commonly agreed framework for evaluation within DECI that will be further developed the coming months

WP7 – Dissemination and exploitation of result
• Promotional infrastructure was created introducing the project vision, partners and pilot sites including clinic settings
• Dissemination opportunities were communicated between partners. Individual and consortium dissemination plans were devised.
• A first IPR committee (IPRC) meeting was held

WP8 – Project Management
• Kick-Off meeting on the 8th and 9th of June 2015 in Milan;
• Consortium meeting on the 21st and 22nd of March 2016 in Enschede;
• Day by day management and periodic alignment calls fortnight and each week in the last month of the project and production of related materials, if any, and minutes;
• Periodical monitoring on activities executed within WPs;
• Supporting of the partners in case of administrative questions and doubts;
• Periodical monitoring on activities executed by each partner;
• Management of relationship and correspondence with the Commission;
• Delivery of the Project Management Plan (D8.1);
• Production of the Y1 technical and financial report (D8.2).

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

Starting from the impact declared in the section 2.1 of the DoA, the contribution performed in the Year 1 is here reported:
• Definition of the KPIs related to patient security, delivered in D1.4 “Key performance indicator to be monitored (clinical management)”, accordingly to a general evaluation framework defined within WP6. Referred to the overall DECI contributions declared in the DoA:
o Outcome evaluation will be conducted versus a control group of patients with similar characteristics but following a traditional care in the same care organization. Indicators and KPIs will constitute a set of evidence of the intervention;
o Improved patient value including wellbeing, awareness of his/her health status, capability to self-manage his/her illness;
o From an ICT supplier’s point of view, set of indicators and business case will be developed, in order to evaluate both effectiveness of the intervention and possibility to replicate the project to manage different forms of socio-care settings.
• Definition of a general Business Model specialized in each pilot site, delivered in D3.1 “Business models and processes with details on procedure for carrying out the various activities and identification of areas for the introduction of IT solutions”. Referred to the overall DECI contribution declared in the DoA: based on the pilots’ results a business case for each country (composed of organisational model and supporting IT solution), based on KPIs will be developed. An important step of the project will address the viability for such models and technologies to be implemented in other care settings including patients’ homes;
• BM feasibility check in each pilot site, accordingly to the local systems, delivered in D3.1 “Business models and processes with details on procedure for carrying out the various activities and identification of areas for the introduction of IT solutions”. Referred to the overall DECI contribution declared in the DoA: reduction of average early hospitalization – or in medical care residences – per groups of patients. Prove cost‐effectiveness feasibility improvements for existing care models via ICT support.

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