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CORDIS

Personalised Connected Care for Complex Chronic Patients

Deliverables

Recommendations of final services and proposals for scale-up integrated care

Report of final recommendation regarding the strategies needed to scale-up the services at the EU level.

Carry out stakeholder analysis as part of a meeting involving all partners

Results about a preliminary meeting with stakeholder performed in the first period of the project will be provided

Adaptive Case Management Design

This deliverable will provide a report on the design of ACM in the healthcare domain

Patient-based Health Risk Assessment and Stratification

This deliverable will report the results coming from T2.3.

Assistive monitoring tools

Technical details about the adopted sensors, the implemented intelligent algorithms, the improvements of eKauri, and experimental results.

Case studies description and the associated co-design process

As a result of the T2.4, a document that will summarise the overall co-design process of the case studies.

Results from CaseStudy2

The results of the CaseStudy2 will be reported in this deliverable

Basic monitoring tools

The basic monitoring algorithms and system, as integrated in the first release of the self-management system (T4.1).

Final dissemination and communication Plan

This deliverable reports on the activities and actions that have been and will be taken to disseminate and use the knowledge and results obtained in CONNECARE.

Results from CaseStudy3

The results of the CaseStudy3 will be reported in this deliverable

Study Release feasibility for the three clinical studies

The study made in T6.1 will be reported in this deliverable to address the feasibility of the Study Release for the three clinical studies.

Advanced monitoring tools

Technical details about the adopted devices, the implemented intelligent algorithms, the corresponding overall system, and experimental results of the advanced monitoring system.

Preliminary dissemination and communication Plan

It states the goals for project-wide information dissemination, identifies the major target groups describing appropriate means for targeting them and outlines process for the clustering with other projects.

Results from CaseStudy1

The results of the CaseStudy1 will be reported in this deliverable.

Final release of the generic CONNECARE system

This deliverable will consists of the Final Release of the generic CONNECARE system. This deliverable will also report the lesson learnt in interoperability models and transfer to other ecosystems.

DARWIN platform for healthcare

This deliverable will report the main changes of DARWIN and the novelty of the new platform. Also the prototype of the platform will be available as deliverable.

QoL Assessment System

The QoL assessment system to be integrated in the final self-management system.

Self-Adaptive Clinical Pathways CDSS

This deliverable will consist of the final release of the self-adaptive clinical pathways CDSS that comes as results of T3.6. Technical details and experimental results of its application will be shown

Stratification and mapping DSS

This deliverable will consist of the final release of the stratification and mapping DSS that comes as results of T3.4 and T3.5. Technical details and experimental results of its application will be shown.

Final Smart Adaptive Case Management System

This deliverable will consist of the final release of the smart adaptive case management system, ready to be integrated in the final CONNECARE system in WP5.

Recommender System for self-management

The recommender system for self-management to be integrated in the final self-management system.

External stakeholder-facing website to assist dissemination and communication

The CONNECARE website that will provide all the information on the project.

First CONNECARE video

First dissemination video that will be produced to promote CONNECARE.

Final CONNECARE video

Final video in which the functionality of CONNECARE will be presented together with its first results.

CONNECARE Newsletter nº2

The second number of the CONNECARE newsletter.

Project factsheet

Twopage document with a brief project presentation containing formal references and CONNECARE main goals key issues technical approach and expected achievement and impacts

CONNECARE Newsletter nº1

The first number of the CONNECARE newsletter.

CONNECARE Newsletter nº3

The third and final number of the CONNECARE newsletter.

Publications

Enhancing the value of care to people: how innovations meet end-users’ needs in integrated care contexts

Author(s): José Ignacio Aznar-Baranda, Isabella Notarangelo, Eloisa Vargiu, John Dinsmore, Cristian Barrue
Published in: International Journal of Integrated Care, Issue 18/s2, 2018, Page(s) 21, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s2021

Implementation of Home Hospitalization and Early Discharge as an Integrated Care Service: A Ten Years Pragmatic Assessment

Author(s): Carme Hernández, Jesus Aibar, Nuria Seijas, Imma Puig, Albert Alonso, Judith Garcia-Aymerich, Josep Roca
Published in: International Journal of Integrated Care, Issue 18/0, 2018, Page(s) 12, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.3431

Comparative analysis of predictive methods for early assessment of compliance with continuous positive airway pressure therapy

Author(s): Xavier Rafael-Palou, Cecilia Turino, Alexander Steblin, Manuel Sánchez-de-la-Torre, Ferran Barbé, Eloisa Vargiu
Published in: BMC Medical Informatics and Decision Making, Issue 18/1, 2018, ISSN 1472-6947
Publisher: BioMed Central
DOI: 10.1186/s12911-018-0657-z

Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial

Author(s): A. Barberan-Garcia, M. Ubre, N. Pascual-Argente, R. Risco, J. Faner, J. Balust, A.M. Lacy, J. Puig-Junoy, J. Roca, G. Martinez-Palli
Published in: British Journal of Anaesthesia, Issue 123/4, 2019, Page(s) 450-456, ISSN 0007-0912
Publisher: Oxford University Press
DOI: 10.1016/j.bja.2019.05.032

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols

Author(s): Erik Baltaxe, Isaac Cano, Carmen Herranz, Anael Barberan-Garcia, Carme Hernandez, Albert Alonso, María José Arguis, Cristina Bescos, Felip Burgos, Montserrat Cleries, Joan Carles Contel, Jordi de Batlle, Kamrul Islam, Rachelle Kaye, Maarten Lahr, Graciela Martinez-Palli, Felip Miralles, Montserrat Moharra, David Monterde, Jordi Piera, José Ríos, Nuria Rodriguez, Reut Ron, Maureen Rutten-van M
Published in: BMC Health Services Research, Issue 19/1, 2019, ISSN 1472-6963
Publisher: BioMed Central
DOI: 10.1186/s12913-019-4174-2

Deliver intelligence to integrate care: the Connecare way

Author(s): Stefano Mariani, Eloisa Vargiu, Marco Mamei, Franco Zambonelli, Felip Miralles
Published in: International Journal of Integrated Care, Issue 19/4, 2019, Page(s) 176, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s3176

Coordination in Socio-technical Systems: Where are we now? Where do we go next?

Author(s): Stefano Mariani
Published in: Science of Computer Programming, Issue 184, 2019, Page(s) 102317, ISSN 0167-6423
Publisher: Elsevier BV
DOI: 10.1016/j.scico.2019.102317

Connected care for complex chronic patients in Lleida

Author(s): Eloisa Vargiu, Gerard Torres, Mireia Masip, Juan Manuel Fernández, Felix Michel, Florian Matthes, Felip Miralles
Published in: International Journal of Integrated Care, Issue 19/4, 2019, Page(s) 102, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s3102

A self-management system for complex chronic patients

Author(s): Eloisa Vargiu, Juan Manuel Fernández, Mauricio Gonzales-Gonzales, Juan Manuel Morales-Garzón, Kitiara Prunera-Moreda, Felip Miralles
Published in: International Journal of Integrated Care, Issue 19/4, 2019, Page(s) 101, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s3101

Network modules uncover mechanisms of skeletal muscle dysfunction in COPD patients

Author(s): Ákos Tényi, Isaac Cano, Francesco Marabita, Narsis Kiani, Susana G. Kalko, Esther Barreiro, Pedro de Atauri, Marta Cascante, David Gomez-Cabrero, Josep Roca
Published in: Journal of Translational Medicine, Issue 16/1, 2018, ISSN 1479-5876
Publisher: BioMed Central
DOI: 10.1186/s12967-018-1405-y

Protocol for regional implementation of collaborative self-management services to promote physical activity

Author(s): Anael Barberan-Garcia, Elena Gimeno-Santos, Isabel Blanco, Isaac Cano, Graciela Martínez-Pallí, Felip Burgos, Felip Miralles, Miquel Coca, Serafín Murillo, María Sanz, Alexander Steblin, Marta Ubré, Jaume Benavent, Josep Vidal, Marta Sitges, Josep Roca
Published in: BMC Health Services Research, Issue 18/1, 2018, ISSN 1472-6963
Publisher: BioMed Central
DOI: 10.1186/s12913-018-3363-8

Patient empowerment in connecare

Author(s): Eloisa Vargiu, Juan Manuel Fernández, Felip Miralles
Published in: International Journal of Integrated Care, Issue 18/s2, 2018, Page(s) 258, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s2258

Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

Author(s): Emili Vela, Ákos Tényi, Isaac Cano, David Monterde, Montserrat Cleries, Anna Garcia-Altes, Carme Hernandez, Joan Escarrabill, Josep Roca
Published in: BMJ Open, Issue 8/3, 2018, Page(s) e017283, ISSN 2044-6055
Publisher: BMJ Publishing Group
DOI: 10.1136/bmjopen-2017-017283

Risk and temporal order of disease diagnosis of comorbidities in patients with COPD: a population health perspective

Author(s): Ákos Tényi, Emili Vela, Isaac Cano, Montserrat Cleries, David Monterde, David Gomez-Cabrero, Josep Roca
Published in: BMJ Open Respiratory Research, Issue 5/1, 2018, Page(s) e000302, ISSN 2052-4439
Publisher: BMJ
DOI: 10.1136/bmjresp-2018-000302

Integrated Care for Complex Chronic Patients

Author(s): Eloisa Vargiu, Juan Manuel Fernàndez, Felip Miralles, Isaac Cano, Elena Gimeno-Santos, Carme Hernandez, Gerard Torres, Jordi Colomina, Jordi De Batlle, Rachelle Kaye, Bella Azaria, Shauli Nakar, M.H. Lahr, Esther Metting, Margot Jager, Hille Meetsma, Stefano Mariani, Marco Mamei, Franco Zambonelli, Felix Michel, Florian Matthes, Jo Goulden, John Eaglesham, Charles Lowe
Published in: International Journal of Integrated Care, Issue 17/5, 2017, Page(s) 302, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.3619

Implementation of digital health tools for scalability of a prehabilitation service

Author(s): Isaac Cano, Anael Barberan-Garcia, Santiago Iriso, Oscar Solans, Felip Miralles, Josep Roca, Graciela Martínez-Pallí
Published in: International Journal of Integrated Care, Issue 19/4, 2019, Page(s) 195, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s3195

Improving self-management of health through an eHealth application: an action-based study among older adults living in the community

Author(s): Margot Jager, Maarten M.H. Lahr, Sophie L.W. Spoorenberg, Erik Buskens, Klaske Wynia
Published in: International Journal of Integrated Care, Issue 18/s2, 2018, Page(s) 113, ISSN 1568-4156
Publisher: Igitur, Utrecht Publishing and Archiving Services
DOI: 10.5334/ijic.s2113

A Practice-Proven Reference Architecture for Model-Based Collaborative Information Systems

Author(s): A. Hernandez-Mendez, F. Michel, F. Matthes
Published in: Enterprise Modelling and Information Systems Architectures – International Journal of Conceptual Modeling, 2018, ISSN 1866-3621
Publisher: German Informatics Society (GI)
DOI: 10.18417/emisa.si.hcm.20

An Integrated Care Intervention Supported by a Mobile Health Tool in Patients Using Noninvasive Ventilation at Home: Randomized Controlled Trial

Author(s): E. Baltaxe, C. Embid, E. Aumatell, M. Martínez, A. Barberan-Garcia, J. Kelly, J. Eaglesham, C. Herranz, E. Vargiu, J.M. Montserrat, J. Roca, I. Cano
Published in: Journal of Medical Internet Research, 2019, ISSN 1438-8871
Publisher: Journal of medical Internet Research

Protocol for regional implementation of community-based collaborative management of complex chronic patients

Author(s): Isaac Cano, Ivan Dueñas-Espín, Carme Hernandez, Jordi de Batlle, Jaume Benavent, Juan Carlos Contel, Erik Baltaxe, Joan Escarrabill, Juan Manuel Fernández, Judith Garcia-Aymerich, Miquel Àngel Mas, Felip Miralles, Montserrat Moharra, Jordi Piera, Tomas Salas, Sebastià Santaeugènia, Nestor Soler, Gerard Torres, Eloisa Vargiu, Emili Vela, Josep Roca
Published in: npj Primary Care Respiratory Medicine, Issue 27/1, 2017, ISSN 2055-1010
Publisher: Nature Publishing Group
DOI: 10.1038/s41533-017-0043-9

Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery

Author(s): Anael Barberan-Garcia, Marta Ubré, Josep Roca, Antonio M. Lacy, Felip Burgos, Raquel Risco, Dulce Momblán, Jaume Balust, Isabel Blanco, Graciela Martínez-Pallí
Published in: Annals of Surgery, 2017, Page(s) 1, ISSN 0003-4932
Publisher: J. B. Lippincott Company
DOI: 10.1097/SLA.0000000000002293

Perspectives on Big Data applications of health information

Author(s): Isaac Cano, Akos Tenyi, Emili Vela, Felip Miralles, Josep Roca
Published in: Current Opinion in Systems Biology, Issue 3, 2017, Page(s) 36-42, ISSN 2452-3100
Publisher: Science Direct
DOI: 10.1016/j.coisb.2017.04.012

Use of a Mobile App by Older People in an Integrated Care Setting

Author(s): Bella Azaria, Rachelle Kaye, Reut Ron, Ofer Chen, Michal Bar-Ilan, Alona Sigalov Zlatkin, Erela Rotlevi, Michal Yeshayahu, Josep Roca, Isaac Cano, Erik Baltaxe, Jordi de Batlle, Gerard Torres, Maarten Lahr
Published in: Impacts of Information Technology on Patient Care and Empowerment, 2020, Page(s) 291-321, ISBN 9781-799800477
Publisher: IGI Global
DOI: 10.4018/978-1-7998-0047-7.ch015

Distributed Speaking Objects: A Case for Massive Multiagent Systems

Author(s): Marco Lippi, Marco Mamei, Stefano Mariani, Franco Zambonelli
Published in: Massively Multi-Agent Systems II - International Workshop, MMAS 2018, Stockholm, Sweden, July 14, 2018, Revised Selected Papers, Issue 11422, 2019, Page(s) 3-20, ISBN 978-3-030-20936-0
Publisher: Springer International Publishing
DOI: 10.1007/978-3-030-20937-7_1

Engineering IoT Systems Through Agent Abstractions: Smart Healthcare as a Case Study

Author(s): Eloisa Vargiu, Franco Zambonelli
Published in: Agents and Multi-Agent Systems for Health Care, Issue 10685, 2017, Page(s) 25-39, ISBN 978-3-319-70886-7
Publisher: Springer International Publishing
DOI: 10.1007/978-3-319-70887-4_2

Coordination of Complex Socio-Technical Systems: Challenges and Opportunities

Author(s): Stefano Mariani
Published in: Software Technologies: Applications and Foundations - STAF 2018 Collocated Workshops, Toulouse, France, June 25-29, 2018, Revised Selected Papers, Issue 11176, 2018, Page(s) 295-310, ISBN 978-3-030-04770-2
Publisher: Springer International Publishing
DOI: 10.1007/978-3-030-04771-9_22

Risk Prediction as a Service: a DSS Architecture Promoting Interoperability and Collaboration

Author(s): Stefano Mariani, Franco Zambonelli, Akos Tenyi, Isaac Cano, Josep Roca
Published in: 2019 IEEE 32nd International Symposium on Computer-Based Medical Systems (CBMS), 2019, Page(s) 300-305, ISBN 978-1-7281-2286-1
Publisher: IEEE
DOI: 10.1109/CBMS.2019.00069

Impact of promotion of physical activity supported by mobile technology on behavioral changes

Author(s): Erik Baltaxe, Anael Barberan-Garcia, Felip Burgos, Carmen Hernandez, Carmen Herranz, Akos Tenyi, Josep Roca, Isaac Cano
Published in: Rehabilitation and Chronic Care, 2018, Page(s) PA2055
Publisher: European Respiratory Society
DOI: 10.1183/13993003.congress-2018.pa2055

A Holistic Model-Based Adaptive Case Management Approach for Healthcare

Author(s): Felix Michel, Florian Matthes
Published in: 2018 IEEE 22nd International Enterprise Distributed Object Computing Workshop (EDOCW), 2018, Page(s) 17-26, ISBN 978-1-5386-4141-5
Publisher: IEEE
DOI: 10.1109/edocw.2018.00014

An Overview of Tools for an Integrated and Adaptive Healthcare Approach

Author(s): Felix Michel, Adrian Hernandez-Mendez, Florian Matthes
Published in: 2018 IEEE 22nd International Enterprise Distributed Object Computing Workshop (EDOCW), 2018, Page(s) 27-32, ISBN 978-1-5386-4141-5
Publisher: IEEE
DOI: 10.1109/edocw.2018.00015

CONNECARE: A Catalan Clinical Controled Trial’case study on the pre-habilitation before major abdominal surgery

Author(s): G. Martinez-Palli, A. Barberan A.
Published in: 2018 Pre-habilitation World Conference, 2018
Publisher: Pre-habilitation World Conference

Implementation of an Integrated Care Platform for the Management of Complex Chronic Patients in Lleida, Spain

Author(s): J. de Batlle, E. Vargiu, G. Torres, M. Massip, F. Michel, F. Matthes, F. Miralles, F. Barbé
Published in: D37. TOPICS IN GLOBAL HEALTH SERVICES RESEARCH, 2019, Page(s) A6246-A6246
Publisher: American Thoracic Society
DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6246

From Healthy to Happy Ageing: the Power of Self-Management

Author(s): Eloisa Vargiu
Published in: Third Italian Workshop on Artificial Intelligence for Ambient Assisted Living 2017 co-located with 16th International Conference of the Italian Association for Artificial Intelligence (AI*IA 2017). Bari, Italy, November 16th and 17th, 2017. CEUR proceedings Vol-2061, pp. 1-3., 2017
Publisher: CEUR

Towards Argumentation-based Recommendations for Personalised Patient Empowerment

Author(s): 1. J.M. Fernandez, M. Mamei, S. Mariani, F. Miralles, A. Steblin, E. Vargiu, F. Zambonelli
Published in: 2017
Publisher: CEUR

Self-Management of Complex Chronic Patients: Needs and A Proposal

Author(s): E. Vargiu, J.M. Fernández, M. Gonzales-Gonzales, J.M. Morales-Garzón, K. Prunera-Moreda, F. Miralles
Published in: Fourth Italian Workshop on Artificial Intelligence for Ambient Assisted Living 2018 (AI*AAL.it), 2018
Publisher: CEUR

KEEP UP WITH CARE: RESEARCHING SYSTEM ADAPTABILITY IN CHRONIC CARE MANAGEMENT OF ELDERLY PATIENTS

Author(s): Michel, Felix; Rehm, Sven-Volker; and Matthes, Florian
Published in: Proceedings of the 27th European Conference on Information Systems (ECIS), 2019, ISBN 978-1-7336325-0-8
Publisher: AIS eLibrary

Opinions of asthma/COPD patients and elderly about the Connecare selfmanagement application

Author(s): Esther Metting
Published in: Primary care respiratory conference, 2018
Publisher: Primary care respiratory conference

Agent abstractions for engineering IoT systems: A case study in smart healthcare

Author(s): Eloisa Vargiu, Franco Zambonelli
Published in: 2017 IEEE 14th International Conference on Networking, Sensing and Control (ICNSC), 2017, Page(s) 667-672, ISBN 978-1-5090-4429-0
Publisher: IEEE
DOI: 10.1109/ICNSC.2017.8000170

Third Generation Teleassistance: Intelligent Monitoring Makes the Difference

Author(s): Xavier Rafael-Palou, Carme Zambrana, Stefan Dauwalder, Enrique de la Vega, Eloisa Vargiu, Felip Miralles
Published in: 2nd Workshop on Artificial Intelligence and Internet of Things @ ECAI2016, 2016
Publisher: CEUR

Coordinating Distributed Speaking Objects

Author(s): Marco Lippi, Marco Mamei, Stefano Mariani, Franco Zambonelli
Published in: 2017 IEEE 37th International Conference on Distributed Computing Systems (ICDCS), 2017, Page(s) 1949-1960, ISBN 978-1-5386-1792-2
Publisher: IEEE
DOI: 10.1109/ICDCS.2017.282

Novel Opportunities for Tuple-based Coordination: XPath, the Blockchain, and Stream Processing

Author(s): Stefano Mariani, Andrea Omicini, and Giovanni Ciatto
Published in: 2017
Publisher: CEUR

Personalized Connected Care for Complex Chronic patients

Author(s): Eloisa Vargiu,Felip Miralles, Juan Manuel Fernández, Xavier Rafael-Palou, Carme Hernandez, Elena Gimeno-Santos, Graciela Martinez-Palli, Isaac Cano, Jordi de Batlle, Gerard Torres, Ferran Barbé5, Bella Azaria, Rachelle Kaye, Ayala Doron, Shauli Nakar, Janwillem WH Kocks, Maarten M.H. Lahr, Erik Busken, Klaske Wynia, Hille Meetsma, Vincet Weijers, Marco Mamei, Stefano Mariani, Franco Zambonelli,
Published in: eHEalth Research 2016, 2016
Publisher: eHealth Research 2016

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