BackgroundThere is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports the intentions of the World Health Organization (WHO) to have integrated people-centered care.ObjectiveTo design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care, and embraces the use of digital technology.MethodsThe overall research method was inspired by action research and used an agile, iterative approach. In 2012, a living lab was established in a Danish municipality which allowed for the freedom of redesigning health care processes. As the first step, a wide group of stakeholders was gathered to create a layout for the reorganization of services and development of technology, based on established principles for innovative management of people with chronic conditions. The next three steps were (1) a proof of concept in 2012, (2) a pilot study, and (3) a feasibility study from 2013 to 2015, in which a total of 93 chronic obstructive pulmonary disease (COPD) patients were enrolled. Citizens were provided a tablet-based solution for remote follow-up and communication purposes, and access to a 24/7 response and coordination center that coordinated both virtual and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed function.ResultsBased on the findings from the iterative process, and evolving technology and workflow solutions, we propose a robust and feasible model that can provide a framework for developing solutions to support an active life with one or more LTCs. The resulting Epital Care Model (ECM) consists of six stages, and serves as a template for how a digitally-enhanced health service can be provided based on patients’ medical needs. The model is designed to be a proactive, preventive, and monitoring health care system that involves individuals in the management of their own health conditions.ConclusionsThe ECM is in accordance with WHO’s framework for integrated people-centered health services, and may serve as a framework for the development of new technologies and provide a template for future reorganization.
Introduction: Many telehealth projects and initiatives loose their pace when facing the barriers of traditional healthcare organization. During the latest years, the concept of disruptive innovation has received increased attention as a method to overcome barriers by introducing new whole system designs as alternative to existing systems. processes, evaluations and clinical evidence on the project iterations. Results to date:The staffed EH call center is implemented in a municipality in the Copenhagen Region. It has started with 5 COPD GOLD Level 3-4 patients included with home technology, and has until now within a year been scaled up to 50. Business cases are developed based on the designed scaling rates, the economic goals and predicted health outcome. Mobile clinical teams are in operation for active prevention of hospitalization. Conclusions:It is important to rethink needs and incentives for all the involved partners, including citizens, in order to enable collaboration under the radical changes, without feeling threatened by savings or reductions. It is a challenge to create a common language and understanding among actors, regarding how the patients turn into active citizens and even consumers in relation to their conditions. Providers must consider changing from a patriarchal behavior to a collaborative one, and accepting the existence of disruptive and competing alternatives within their healthcare system. These initiatives have large impact and promisebut must start small due to their disruptive nature.
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