Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

Abstract

Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk.

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case

“…Likewise, empowerment of patients for self-management of their condition constitutes an essential goal of the service. The requirements for digital support in the scalability of prehabilitation have been formulated in detail in [ 43 ] and commercial promotion will be initiated within 2021 through the spin-off company Health Circuit [ 44 ]. It is of note that the technological support facilitating service modularity and personalization as well as interoperability between community-based facilities, including patient’s home, and hospital-based information systems has been achieved in the health district of Barcelona-Esquerra (520 k inhabitants).…”

“…• Enhanced risk assessment for personalization of interventions is needed to facilitate fine-tuning of the three-layer service design described above. • Maturity of digital support constitutes a high priority to optimize prehabilitation outcomes [26,43]. • Future co-creation initiatives aiming at service refinement should address specific, and narrower, targets to ensure short-term achievements.…”

“…Maturity of digital support constitutes a high priority to optimize prehabilitation outcomes [ 26 43 ].…”

Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case

“…We could hypothesize that comprehensive outcomes' assessment using properly validated visual-analogic scales and/ or artificial intelligence-powered brief questionnaires [56] could be alternative approaches to be explored for a desirable adoption of Triple Aim assessment in routine healthcare delivery assessment. The use of user-friendly digital tools conceived to support collaborative work and adaptive case management, as described in [57], should greatly facilitate capturing patients' information. Such digital tools should also allow a fluent capture of professional inputs allowing Quadruple Aim [16] assessment of healthcare services.…”

Patient-Tailored Approach for Enhanced Recovery after Surgery

“…Several meta-analyses [29,30] and randomized trials [31,32] have reported the benefits for prehabilitation programs. Only a few studies have identified clinical benefits with the use of prehabilitation in an ERAS ® setting [33].…”