DEDICATE: proposal for a conceptual framework to develop dementia-friendly integrated eCare support

Abstract

BackgroundEvidence shows that the implementation of information and communication technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual’s whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used.MethodsStarting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements.ResultsWe identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients’ and informal caregivers’ preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (formal support services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (care coordination services, CCS).ConclusionsThe proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation).

How to create value with unobtrusive monitoring technology in home-based dementia care: a multimethod study among key stakeholders

“…However, this does not necessarily mean that such stakeholders might not become important. The trend towards care collaboration and integrated dementia care [ 42 ] suggests that those specialists might affect or be affected by UM technology in the future.…”

Exemplary Care among Chinese Dementia Familial Caregivers

“…In addition, C-ECS provides a more comprehensive assessment of the quality-of-care continuum, and is useful to familial caregivers and volunteers, but also to researchers and healthcare professionals who are interested in quality of informal care and should be considered linking to a Social Ecological Model (the C3P Model) [50], the Information Communication Technology-based framework such as eCare solutions in the DEDICATE architecture service delivery [51] and dementia palliative and end-of-life care approach [52,53,54] and to continual improvement in care and education in clinical and care settings such as the Exemplary Care and Learning Site (ECLS) model [5] so that better patient outcomes, notably quality-of-life, and the full spectrum of person-centered services with lower costs, can be delivered to these patients and their families across an individual’s whole dementia journey.…”

Telemedicine Digital Platforms: A Systematic Literature Review

“…Then, record and information presentation mechanisms need to be in place that keep knowledge available and actively refreshed, in a way that is in line with the individual's persona and expectations. (Marceglia et al, 2018) Overall, the interview results in a study by imply that a collaboration which uses technology along with an appropriate Business Model may be more successful for future healthcare delivery. Therefore, a more holistic connected healthcare industry blueprint and vision would be important for designing and engineering such ecosystems in Taiwan.…”

“…There is currently a strong likelihood that the pattern of care becomes provider-driven. Thus, at the very time that the person is vulnerable and needing help, their lifestyle is changed around them (Marceglia et al, 2018). When considering telehealth, the presence of the physician is necessary for the healthcare delivery process to happen.…”

“…Informal family care, representing the cornerstone in almost every country, is sometimes supported or supplemented by paid home caregivers, respite opportunities and palliative end-of-life care. (Marceglia et al, 2018) Lastly, one of the most mentioned sides was government participation, mainly due to public funding and public health concerns (Mukhopadhyay & Bouwman, 2018;Vezyridis & Timmons, 2015;Visconti & Morea, 2020). The platform may create a segmentation of different types of users within each side, complementing the MSBM other combinations can be used such as the freemium approach, where the platform has a free layer but users can pay to have extra functionalities, more use time (Ardolino et al, 2020).…”