Home Sweet Home: a telemonitoring solution to

0 downloads 0 Views 278KB Size Report
the “Home Sweet Home” project by the Badalona Serveis Assistencials (BSA), an integrated private health and social care organisation ... (A) the potential Value if that class of Unmet Needs is fully addressed; ... fire detector, movement detector, etc. 3 .... 12". Area"COL.1"""". On"the"management"of"an"individual"care"plan".
This  document  represents  a  Value-­‐Oriented  Map  (VOM)  about  the  following  initiative:  

Home  Sweet  Home:     a  telemonitoring  solution  to  support  independent  living   Topic:     Health  monitoring  and  social  integration  to  extend  the  independent  life  of  elderly  people   Where  and  when:    The  activities  were  performed  in  the  town  of  Badalona  (Catalonia)  from  2010  to  2014  within   the  “Home  Sweet  Home”  project  by  the  Badalona  Serveis  Assistencials  (BSA),  an  integrated  private  health  and   social  care  organisation  with  entirely  public  capital.   abstract:   The   Project   HOME   SWEET   HOME   (HSH)   brings   together   a   set   of   services   which,   combined,   allow   extending   the   independent   life   of   elderly   people.   HSH   is   trialling   a   new,   economically   sustainable   home   assistance  service  which  extends  elders  independent  living.     HSH   provides   a   comprehensive   set   of   services   which   support   elders   in   their   daily   activities   and   allows   carers   to   remotely  assess  their  ability  to  stay  independent.  HSH  privileges  features  which  the  elders  themselves  can  use   and  limits  the  need  for  other  people  to  interfere  with  their  private  life,  unless  the  system  detects  a  clear  need.     In  Badalona,  the  project  adopted  for  the  first  time  a  telemonitoring  solution,  which  was  deployed  on  the  top  of   the  local  initiative  on  Home  hospitalization  (HDI).   The  project  measures  the  impact  of  monitoring,  cognitive  training  and  e-­‐Inclusion  services  on  the  quality  of  life   of  the  elderly,  on  the  cost  of  social  and  healthcare  delivered  to  them,  and  on  a  number  of  social  indicators.       GLOSSARY:   Home   Sweet   “Health   monitoring   and   sOcial   integration   environMEnt   for   Supporting   WidE   ExTension   of   Home  (HSH)   independent   life   at   HOME”,   a   European   Project   in   the   ICT   Policy   Support   Programme   (ICT   PSP),  Project  ID  250449,  See  https://cordis.europa.eu/project/rcn/191712_en.html     and  https://apps.bsa.cat/drupal/?q=node/22   BeyondSilos   a   European   Project   in   the   ICT   Policy   Support   Programme   (ICT   PSP),   Project   ID   621069,   http://beyondsilos.eu/project/project-­‐overview.html   –   See   the   related   Value-­‐Oriented   Maps   (VOM)  in  the  documents  CB14  (program  #1  on  short-­‐term  rehabilitation)  and  CB15  (program   #2  on  long  term  maintenance  of  stable  conditions)  of  this  series   geriatric  team  

the  patient  was  identified  by  the  geriatrician  at  the  intermediate  care  centre,  which  was  also   managing   the   follow-­‐up   at   home   together   with   a   nurse.   See   the   local   initiative   on   Home   hospitalization  (HDI)     Home   a   local   initiative   in   Badalona.   In   its   first   period   (from   2012   to   2010)   it   was   targeting   elderly   hospitalization   patients  at  home  coming  from  the  intermediate  center  care,  and  the  patient  remained  under   (HDI)   the  responsibility  of  the  geriatrician.     See  the  related  Value-­‐Oriented  Map  in  the  documents  CB01  of  this  series.     The   following   tables   contain   in   the   right   column   a   qualitative   assessment   of   the     CV   brought  to  the  care  model  of  this  local  initiative  in  correspondence  to  each  class  of  the  Classification  of  Unmet   Needs  (in  the  first  column);  the  second  column  provides  annotations  related  to  the  local  deployment.     The  CVs  result  from  a  combination  of  two  criteria:     (A)  the  potential  Value  if  that  class  of  Unmet  Needs  is  fully  addressed;     (B)  the  ability  of  the  innovative  components  in  the  local  model  to  address  that  class  of  Unmet  Needs.     The  scores  are  as  follows:     0  =     class  of  Unmet  Need  not  addressed;     1  =   class  indirectly  addressed;     2  =     the  induction  of  spontaneous  innovation  of  care  processes  yields  a  partial  satisfaction  of  criteria;     3  =     a  significant    influence  on  roles  of  professionals  and  recipients  fully  satisfies  just  one  criterion;     4  =     the  structural  innovation  of  care  processes  fully  satisfies  both  criteria.        

Pillar  COL  –  Needs  to     improve  the  collaboration  among  the  actors  of  the  care  process   Area  COL.1     On  the  management  of  an  individual  care  plan   a.  set  up,  refinement  and  update  of   individual  care  plans  by  a  multidisciplinary   team  

Care  plan  is  decided  among  the  geriatric  team  at  the  intermediate  care   centre.  

b.  a  systematic  medical  supervision  in  the   course  of  a  care  plan  

The  geriatric  team  takes  care  of  the  supervision.  

c.  coordination  in  implementing  the  tasks   within  an  individual  care  plan  

The  geriatric  team  coordinates  with  other  units  outside  of  the  project.  

Area  COL.2      On  the  collaborative  tasks  among  the  professionals  taking  care  of  a  patient  

 

 

  3   3   3    

a.  reciprocal  awareness  of  patient’s   contacts  and  health  problems  among   involved  professionals  

Full  registration  of  contacts  of  the  patient  with  the  health  and  social  care   system  through  the  EMR  and  ICR  

4  

b.  direct  interaction  among  concerned   professionals  (incl.  consultation)  

Good  connection  among  the  involved  team  in  the  project  and  the  rest  of   homecare  teams.  

3  

c.  recording  and  sharing  of  relevant  patient   All  patient  data  is  recorded  and  shared  through  the  specific  platform  provided   data   by  the  project.  Not  integrated  with  the  EMR  though,  so  need  to  go  to  it  “on   3  

purpose”.  Same  platform  as  in  BeyondSilos  but  less  integrated.  

Area  COL.3      On  the  remote  provision  of  care  and  cure  services  

 

a.  coping  with  the  distance  between   professionals  and  patients  (incl.  tele-­‐ health,  tele-­‐care)  

Full  telehealth  and  telecare  solution  including  domotics,  panic  button  (indoors   4   and  outdoors),  medical  devices,  cognitive  training,  etc.  

b.  handling  predictable  incidental   situations  

The  telemonitoring  solution  allows  to  predict  exacerbation  of  the  chronic   conditions  and  to  effectively    deal  with  them.  

Area  COL.4      On  the  transition  between  care  settings   a.  patient’s  transition  from  hospital  to   primary  care  facilities  

N/A  (tackled  in  other  initiatives)  

Pillar  ENG  –  Needs  to     improve  the  engagement  of  patient  and  caregiver   Area  ENG.1      On  the  management  of  general  information  and  knowledge  

4     0  

   

a.  patient  involvement  in  defining  the  care   N/A  (in  the  Catalonian  environment)   contract  and  allocating  its  personal  budget  

0  

b.  patient’s  awareness  on  facilities  and   procedures  

3  

Full  information  set  delivered  to  patients  and  caregivers  on  procedures    

Area  ENG.2      On  the  patient  and  the  caregiver  managing  their  health   The  technological  platform  giving  pre-­‐defined  recommendations  according  to   the  chronic  conditions  and  also  personalized  messages  coming  from  the   formal  caregivers  (project  team)   b.  patient’s  adherence  to  the  individual   Continuous  follow-­‐up  by  the  technology  on  accomplishment  on  the  care  plan   care  plan   (even  including  medication  intake)   c.  timely  interactions  with  patient  /   Both  patients  and  informal  caregivers  trained  to  manage  their  own  chronic   caregiver  on  issues  arising  during  self-­‐care   conditions.   a.  patient’s  skills  on  healthy  life  styles,   clinical  knowledge,  therapies  

activities  

Area  ENG.3      On  the  suitability  of  the  patient’s  environment   The  platform  includes  a  built-­‐in  videoconferencing  system  installed  at  the  TV   set  to  contact  relatives  and  friends   b.  supporting  ADLs  and  IADLs   Follow-­‐up  by  the  project  team.  No  specific  actions  taken  in  that  sense.   a.-­‐  social  inclusion  

c.  “age  friendly”  buildings,  cities  and   environment    

  3   4   3     3   2  

Installed  at  home  automatic  locks  for  doors  and  windows.  Also  flood  detector,   3   fire  detector,  movement  detector,  etc.  

Pillar  DEC  –  Needs  to     improve  the  strategic,  managerial  and  clinical  decisions  

 

Area  DEC.1      On  feeding  dashboards  and  producing  reports   a.  exploitation  of  regional  /  national   Not  used  in  the  context  of  the  project   managerial  and  administrative  data   streams   b.  exploitation  of  routine  data  collected  in   Used  at  local  level   service  delivery  for  management  purposes   c.  exploitation  of  routine  data  collected  in   Used  at  local  and  regional  level   service  delivery  for  strategic  decision-­‐ making  

  1   3   3  

Area  DEC.2      On  supporting  decisions  on  individual  patients   a.  supporting  clinical  decisions  by  the     professionals  taking  care  of  a  patient   b.  redundant  or  contrasting  multi-­‐drug   N/A  not  the  objective  of  this  project   therapy   c.  risk  assessment  and  citizens  stratification   Not  used  in  this  project.   for  enrolment  in  specific  programs  

  3   0   1  

  Disclaimer:  the  CV  scores  in  the  above  tables  depend  on  the  local  context  in  the  particular  timeframe.     In  case  of  similar  initiatives  in  other  localities  the  CV  scores  must  be  re-­‐assessed  by  the  local  stakeholders     with  Delphi  cycles  alternating  individual  assessments  and  panel  discussions.     Discussion:  The  main  goal  of  the  project  was  to  extend  the  opportunity  for  independent  life  of  elderly  people  at   home  through  telemonitoring.     As  it  could  be  expected,  the  components  that  bring  most  of  the  Value  to  the  Care  Model  are  addressing  the   Unmet  Needs  in  the  Areas  COL.2  (on  the  collaborative  tasks  among  the  professionals  taking  care  of  a  patient)   and  ENG.2  (on  the  patient  and  the  caregiver  managing  their  health).     Further   contribution   to   the   overall   Value   is   given   also   by   the   Areas   COL.1   (on   the   management   of   an   individual   care  plan)  and  ENG.3  (on  the  suitability  of  the  patient’s  environment).     The  initiative  reach  an  overall  high  score  of  the  Contingent  Complexity  of  Deployment  Index:  CCD  =  64%.     The  HSH  Project  started  in  2010.  It  may  be  compared  with  the  subsequent  BeyondSilos  project,  which  started   in  2014,  and  was  based  on  the  same  platform.  BeyondSilos  deployed  two  different  Integrated  Care  Pathways   (ICPs):  the  program  #1  on  short-­‐term  rehabilitation  with  a  CCD  =  68%  (see  CB14)  and  the  program  #2  on  long-­‐ term  maintenance  of  stable  conditions  with  a  CCD  =  75%  (see  CB15).  In  other  words,  the  care  models  in  both   programs  in  BeyondSilos  were  more  complex  and  integrated,  yielding  a  higher  CCD  Index.     The  technologies  played  an  important  role  in  this  project.   HOME  SWEET  HOME  (HSH)  trialed  a  new,  economically  sustainable  home  assistance  service.   HSH   achieved   this   by   providing   a   comprehensive   set   of   services   supporting   elderly   people   in   their   daily   activities  and  allows  carers  to  remotely  assess  their  ability  to  stay  independent.     While  systems  of  this  kind  inevitably  represent  an  intrusion  in  the  elders'  private  life,  HSH  privileged  features   which   can   be   used   by   the   elders   themselves   and   limits   to   a   bare   minimum   the   need   for   other   people   to   interfere  with  their  private  life  unless  a  clear  need  is  detected  by  the  system.     It  comprised  the  following  services:     • The  Monitoring  and  Alarm  Handling  is  based  on  a  DSS  which  analyses  in  real  time  data  collected  from   medical   and   environmental   sensors,   fall   detectors   and   geopositioning   systems.   Standard   behavioural   patterns  are  established  for  individuals  and  sudden,  major  changes  trigger  alarms.     • eInclusion   is   achieved   through   intuitive   videoconferencing   based   on   the   familiar   TV   paradigm   and   adapted  to  use  by  people  unfamiliar  with  IT  technology.     • Domotics  and  Daily  Scheduler  help  elders  to  organise  their  daily  activities  and  to  manage  the  house  in   spite  of  growing  physical  and  mental  impairments.     • The   navigation   system   takes   people   who   got   lost   to   the   closest   safe   place.   Cognitive   training   is   implemented   through   interactive   games   based   on   cognitive   adaptive   technology.   Complexity   of   exercises  is  adjusted  to  the  performance  and  current  mental  level  of  the  user.    

From   one   side   the   telemonitoring   solution   allows   to   increase   the   contacts   with   the   patient   and   thus   a   more   continuous  presence,  alternating  the  virtual  sessions  with  in-­‐person  presence.   From   the   other   side   the   Integrated   Care   Record   allows   to   maintain   a   precise   history   of   the   evolution   of   the   patient’s   conditions;   moreover   all   the   professionals   can   be   reciprocally   aware   of   the   activities   performed   on   the  patient  and  by  the  patient,  as  well  as  they  can  set  automatic  alerts  that  may  require  specific  interventions.    

HomeSweetHome"2008!! 0"

2"

4"

6"

8"

10"

12"

Area"COL.1"""" On"the"management"of"an"individual"care"plan" Area"COL.2"""" On"the"collabora?ve"tasks"among"the"professionals"taking"care"of"a"pa?ent" Area"COL.3"""" On"the"remote"provision"of"health"services"

a"

Area"COL.4"""" On"the"transi?on"between"care"seDngs"

b"

Area"ENG.1"""" On"the"management"of"general"informa?on"and"knowledge"

c"

Area"ENG.2"""" On"the"pa?ents"and"the"caregivers"managing"their"health" Area"ENG.3"""" On"the"suitability"of"the"pa?ent’s"environment" Area"DEC.1"""" On"feeding"dashboards"and"producing"reports" Area"DEC.2"""" On"suppor?ng"decisions"on"individual"pa?ents"

     

 

BeyondSilos,  Program  #2  on  long-­‐term  maintenance  of  stable  conditions  (see  CB15)   BeyondSilosMlong"2013!! 0"

2"

4"

6"

8"

10"

12"

Area"COL.1"""" On"the"management"of"an"individual"care"plan" Area"COL.2"""" On"the"collabora?ve"tasks"among"the"professionals"taking"care"of"a"pa?ent" Area"COL.3"""" On"the"remote"provision"of"health"services"

a"

Area"COL.4"""" On"the"transi?on"between"care"seDngs"

b"

Area"ENG.1"""" On"the"management"of"general"informa?on"and"knowledge"

c"

Area"ENG.2"""" On"the"pa?ents"and"the"caregivers"managing"their"health" Area"ENG.3"""" On"the"suitability"of"the"pa?ent’s"environment" Area"DEC.1"""" On"feeding"dashboards"and"producing"reports" Area"DEC.2"""" On"suppor?ng"decisions"on"individual"pa?ents"

 

     

doc  ID:  CB13  v.06  

date:  2018-­‐08-­‐28  

authors:  JPJ  (ARM)