BackgroundIn response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes.ObjectiveThe objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations.MethodsSemistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario.ResultsThe added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning.ConclusionsAlthough integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves.
ProACT, a Horizon 2020 project, aims to develop a technology ecosystem to support integrated care for older persons with multimorbidity (PwMs). The ecosystem will connect four key models of care and support -1) homecare (including informal care), 2) hospital care, 3) community and social care 4) social support networks -and will be centred on the person at home self-managing their conditions with support from their care network. The development of a digital platform for integrated care has the potential to support existing practice, and to improve the management of a complex and integrated care plan, introducing new ways of collaboration between key actors.To understand care pathways for PwMs, we mapped the existing pathways across three EU countries -Ireland and Belgium, where ProACT will be trialled with 60 older adult participants and their care networks at each site, and Italy where a transferability study will take place.We also identified key stakeholders in the care ecosystems and conducted interviews and focus groups with 166 participants (including PwMs and support actors -informal and formal carers, pharmacists and a range of healthcare professionals) across the three countries, in order to understand their needs, requirements, challenges and expectations in relation to the potential use of ProACT.Some of the major challenges identified in this research involve the lack of standardised, integrated pathways for multimorbidity across the three countries. To better understand pathways for chronic disease management, we reviewed and compared the British NHS NICE pathways for single disease management of the ProACT conditions COPD, CHD, CHF and Diabetes. We adapted these pathways for each of the four ProACT conditions, focusing on those areas of relevance to the patient. We then compared these with existing pathways identified in each region. From this process, we identified 4 important steps within each individual disease pathway, as well as general older adult care pathways. These are:
Due to changes in the demographic situation of most Western European countries, interest in Information and Communication Technologies (ICT)-supported care services is growing fast. eCare services that foster better care information exchange, social involvement, lifestyle monitoring services, etc., offered via ICT platforms, integrated in the homes of the elderly are believed to be cost-effective. Additionally, they could lead to an increased quality of life of both care receiver and (in)formal caregiver. Currently, adoption and integration of these eCare platforms (eCPs) is slowed down by several barriers such as unclear added value, a lack of regulations, or lack of sustainable financial models. In this work, the added value of eCPs is identified for the several involved key actors such as the care receiver, the (in)formal care providers, and the home care organizations. In a second step, several go-to-market strategies are formulated. Because the gap between the current way of providing home care and providing home care supported by a fully integrated eCP seems too big to bridge in one effort, a migration path is provided for stepwise integration and adoption of eCPs in the current way of home care provisioning.
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