Periodic Reporting for period 3 - VALUECARE (VALUE-BASED METHODOLOGY FOR INTEGRATED CARE SUPPORTED BY ICT)
Periodo di rendicontazione: 2022-12-01 al 2024-09-30
Healthy ageing and independent living have become key challenges for Europe as the number of older persons grows. Several organisations stressed the importance of independence, participation and autonomy of older people to stay healthy and thus to ensure their quality of life.
ValueCare (VC) aimed to:
1) deliver efficient outcome-based integrated care to older people facing cognitive impairment, frailty and multiple chronic conditions to improve their quality of life (and of their families)
2) contribute to the sustainability of the health and social care systems in Europe
3) provide a secure, scalable and robust digital solution for integrated care.
VC took into account job satisfaction and wellbeing of health and social care providers, moving from the Triple to the Quadruple Aim. The project’s digital solution was tested and evaluated in 7 pilots in Europe using a sound methodology, after development by the technical partners together with end-users. VC proposed greater efficiency in the use of resources and coordination of care in a setting that ensures trust of users and policy makers about data access, protection and sharing and standardisation that can be replicated in the EU. The consortium (17 partners from 8 countries) was built to guarantee full coverage of scientific, technological, clinical and social competencies and to gather viewpoints of different actors necessary to develop, test and evaluate the concepts, paradigms, protocols and interventions related to VC. The consortium had stakeholders from digital health and social care to maximise success. Evaluation of the data show that VC is a promising approach but further development and implementation, combined with evaluation research, is recommended.
Key findings are:
1. Health outcomes of the older people of the VC intervention group showed some favorable statistically significant results. These were:
o The level of independence significantly improved in the intervention group compared to the control group at 6-12 month follow-up.
o The physical and mental health significantly increased in the intervention group compared to the control group at 12-18 month follow-up.
o For care use, across all pilots together, participants in the intervention group had significant reductions in needing help to care for oneself due to health problems compared to participants in the control group; this was significant at both follow-up moments.
2. There were a few unexpected unfavorable outcomes for which we have no explanation. Unexpectedly, the risk for inappropriate medication use increased in the intervention group at 12-18 month follow-up.
3. The budget impact analyses, from the healthcare perspective show that in the VC intervention group there was a decrease of the total healthcare costs (-67 euros per participant); while in the control group, between baseline and follow-up the total costs increased (+189 euros per participant).
ValueCare (VC) aimed to:
1) deliver efficient outcome-based integrated care to older people facing cognitive impairment, frailty and multiple chronic conditions to improve their quality of life (and of their families)
2) contribute to the sustainability of the health and social care systems in Europe
3) provide a secure, scalable and robust digital solution for integrated care.
VC took into account job satisfaction and wellbeing of health and social care providers, moving from the Triple to the Quadruple Aim. The project’s digital solution was tested and evaluated in 7 pilots in Europe using a sound methodology, after development by the technical partners together with end-users. VC proposed greater efficiency in the use of resources and coordination of care in a setting that ensures trust of users and policy makers about data access, protection and sharing and standardisation that can be replicated in the EU. The consortium (17 partners from 8 countries) was built to guarantee full coverage of scientific, technological, clinical and social competencies and to gather viewpoints of different actors necessary to develop, test and evaluate the concepts, paradigms, protocols and interventions related to VC. The consortium had stakeholders from digital health and social care to maximise success. Evaluation of the data show that VC is a promising approach but further development and implementation, combined with evaluation research, is recommended.
Key findings are:
1. Health outcomes of the older people of the VC intervention group showed some favorable statistically significant results. These were:
o The level of independence significantly improved in the intervention group compared to the control group at 6-12 month follow-up.
o The physical and mental health significantly increased in the intervention group compared to the control group at 12-18 month follow-up.
o For care use, across all pilots together, participants in the intervention group had significant reductions in needing help to care for oneself due to health problems compared to participants in the control group; this was significant at both follow-up moments.
2. There were a few unexpected unfavorable outcomes for which we have no explanation. Unexpectedly, the risk for inappropriate medication use increased in the intervention group at 12-18 month follow-up.
3. The budget impact analyses, from the healthcare perspective show that in the VC intervention group there was a decrease of the total healthcare costs (-67 euros per participant); while in the control group, between baseline and follow-up the total costs increased (+189 euros per participant).
The partners collaborated to further detail the requirements for the project. Because of COVID-19, new, safe ways of working were introduced using online tools. In monthly online consortium meetings the status and any occurring issues were discussed. There were scheduled and ‘ad-hoc’ meetings within and between WPs and with the Advisory Board to make progress. Finally, 4 face-to-face meetings were organised.
Regarding the development of new integrated care built on the value-based methodology, we achieved:
1) Definition of the value-based framework including ICT requirements through literature research, co-design with end-users and collaboration among all partners; Identification of clerical and clinical data needed in the project
2) Recruitment of different target groups through various engagement strategies and methodologies suitable for each pilot
3) Co-design activities in pilots to collect information about the target group, and the care pathways; discussion of the VC concept with end-users and collection of user experiences.
Together with all partners and local stakeholders, using a co-design approach, a digital solution with three components was developed: 1) Virtual Coach, 2) Mobile Application and 3) Web Dashboard. Algorithms for the virtual coach dialogues were defined and developed within each pilot separately. The cloud infrastructure for hosting the VC solution was set up, and the digital solution was adapted for each pilot.
For the pilot implementation, preparatory work, including involving local stakeholders, was done. Pilots had guidelines to adapt the general framework to the local context. Recruitment took place and the VC approach was deployed in the intervention group in each pilot. Progress differed between pilots for several reasons, but all pilots finished recruitment, implemented the intervention, and collected the two follow-up questionnaires.
The earlier designed evaluation framework was used to evaluate the effectiveness and implementation of VC. Questionnaires for all target groups were developed for the 3 measurement time points. Debriefing interviews were done for collecting qualitative data; the results of these interviews were used to encourage continuous learning. Several intermediate statistical analyses were performed, and a final analysis was done to summarise the results.
A dissemination and communication strategy was created mainly aiming at the general public, policy makers and service managers. There is a website where information about the project, the pilots, blog items and news articles were posted. A Twitter account, LinkedIn profile and podcast were developed and regularly being updated.
Moreover, each partner carried out different activities, including participation in conferences/webinars/workshops, creating promotional materials for local distribution and managing local social media pages.
For the exploitation and innovation, active collaboration between the WPs took place specifically regarding co-design activities, user requirements and technical specifications of the digital solution, stakeholder mapping and evaluation framework. Identification of relevant stakeholders was done. A business exploitation plan was developed. The consortium and external stakeholders were involved in gathering the information needed to develop the business plan.
The high importance of ethics and data protection was recognised throughout the project. In RP3, the VC Ethics Committee gathered, final versions of the ethical management plan, ethical guidelines and templates and data management plan have been written.
Regarding the development of new integrated care built on the value-based methodology, we achieved:
1) Definition of the value-based framework including ICT requirements through literature research, co-design with end-users and collaboration among all partners; Identification of clerical and clinical data needed in the project
2) Recruitment of different target groups through various engagement strategies and methodologies suitable for each pilot
3) Co-design activities in pilots to collect information about the target group, and the care pathways; discussion of the VC concept with end-users and collection of user experiences.
Together with all partners and local stakeholders, using a co-design approach, a digital solution with three components was developed: 1) Virtual Coach, 2) Mobile Application and 3) Web Dashboard. Algorithms for the virtual coach dialogues were defined and developed within each pilot separately. The cloud infrastructure for hosting the VC solution was set up, and the digital solution was adapted for each pilot.
For the pilot implementation, preparatory work, including involving local stakeholders, was done. Pilots had guidelines to adapt the general framework to the local context. Recruitment took place and the VC approach was deployed in the intervention group in each pilot. Progress differed between pilots for several reasons, but all pilots finished recruitment, implemented the intervention, and collected the two follow-up questionnaires.
The earlier designed evaluation framework was used to evaluate the effectiveness and implementation of VC. Questionnaires for all target groups were developed for the 3 measurement time points. Debriefing interviews were done for collecting qualitative data; the results of these interviews were used to encourage continuous learning. Several intermediate statistical analyses were performed, and a final analysis was done to summarise the results.
A dissemination and communication strategy was created mainly aiming at the general public, policy makers and service managers. There is a website where information about the project, the pilots, blog items and news articles were posted. A Twitter account, LinkedIn profile and podcast were developed and regularly being updated.
Moreover, each partner carried out different activities, including participation in conferences/webinars/workshops, creating promotional materials for local distribution and managing local social media pages.
For the exploitation and innovation, active collaboration between the WPs took place specifically regarding co-design activities, user requirements and technical specifications of the digital solution, stakeholder mapping and evaluation framework. Identification of relevant stakeholders was done. A business exploitation plan was developed. The consortium and external stakeholders were involved in gathering the information needed to develop the business plan.
The high importance of ethics and data protection was recognised throughout the project. In RP3, the VC Ethics Committee gathered, final versions of the ethical management plan, ethical guidelines and templates and data management plan have been written.
The consortium aimed to increase quality of care at lower costs resulting in a positive socio-economic impact in participating countries and Europe as a whole. Overall, as was written above, for all pilots together, the evaluations showed favorable results regarding some of the measured outcomes. However, more studies with more participants (especially care professionals) are needed to confirm whether the VC approach leads to better outcomes in the intervention group compared to the control group, at lower costs. The qualitative analyses show that the participants appreciated the VC approach, and recognise its potential. The users recommend further development of the VC app, because the current experimental version showed some challenges during implementation.