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Introducing personalized healthcare in daily clinical practice - - PowerPoint PPT Presentation

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Introducing personalized healthcare in daily clinical practice Miriam Vollenbroek-Hutten Introduction Chronic diseases are the leading cause of mortality and morbidity in Europe Traditionally chronic diseases concern,

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“Introducing personalized healthcare in daily clinical practice”

Miriam Vollenbroek-Hutten

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Roessingh Research and Development, Enschede, the Netherlands

  • Chronic diseases are the leading cause
  • f mortality and morbidity in Europe
  • Traditionally chronic diseases concern,

cardiovascular disease, diabetes and asthma or chronic obstructive pulmonary disease (COPD) chronic pain.

  • As survival rates and durations have

improved, nowadays chronic diseases also concern many varieties of cancer, HIV/AIDS, mental disorders and disabilities such as sight impairment and arthroses

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Introduction

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Commonalities of chronic diseases

  • they need a long-term and complex response, coordinated by

different health professionals

  • They need access to the necessary drugs and equipment, treatments

like physiotherapy, cognitive behavioral treatment and extending into social care.

  • Improving vitality and functional status is key

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Introduction

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However Most health care today, however, is still structured around acute episodes Main Challenges

  • Prevention and early detection
  • Coordinating care for individual

chronic diseases: DMPs

  • Managing care across chronic

diseases: integrated care models

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Introduction

Chronic Care Model, Wagner 2001

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Roessingh Research and Development, Enschede, the Netherlands

Marco Rogante1, Mauro Grigioni1, Daniele Cordella2, Claudia Giacomozzi1

1Technologies and Health Department, Italian National Institute of Health, Rome, Italy 2SIDBAE Informatic Sector, Italian National Institute of Health, Rome, Italy

This paper aims at delivering a structured overview of telerehabilitation literature by analysing the entire set

  • f articles under the search terms "telerehabilitation" or "tele-rehabilitation" to portray "state of the art" ten

years after the publication of the first scientific article on the topic. A structured study has been conducted by considering all those articles containing the word "telerehabilitation" or "tele-rehabilitation". Medline, Embase, Cochrane, UK Centre for Reviews and Dissemination, Canadian Agency for Drugs and Technologies in Health databases have been interrogated for articles between 1998 and 2008. 146 scientific articles were found. 56 articles focus on patient treatment, 23 are reviews, 3 are to be considered as both patient treatment papers and reviews, 53 are either technical reports, system descriptions or analyses of new approaches; 8 are general discussion on telerehabilitation. The present paper draw the scenario of the first ten years of telerehabilitation, focussing on clinical applications and technologies. Basically, it confirms the lack of comprehensive studies providing evidence for supporting decision and policy-makers in adopting telerehabilitation technologies in the clinical practice. An overall lack of standardisation in the used terminology also results from the analysis of keywords, which is typical of quite recent fields of application.

Category 1 – synchronous communication technologies Category 2 – asynchronous communication technologies Category 3 – sensor-based technologies Category 4 – exercise-applications Category 5 - virtual reality and gaming

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Rogante, M., et al., Ten years of telerehabilitation: A literature

  • verview of technologies and clinical applications.

NeuroRehabilitation, 2010. 27(4): p. 287-304.

Current status

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Professional-professional Patient-professional

Current status

Currently finding it way in clinical practice are Category 1 and Category 2

  • Video consultation

between professionals

  • Videoconsultation

between patients and professionals

  • E-mail consultation
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Category Number of paper Technology Clinical purposes Synchronous communication 24 papers 1 paper 1 paper Videoconferencing Telephone Telephone +webcam To enable contact between patient and professionals A-synchronous communication technology 4 papers 2 papers E-mail Asychronous messaging technology To enable contact between patient and professionals Sensor based technology 26 papers 8 papers ECG, O2 7 papers HR, BP 9 papers motion detection 3 papers EMG Secure exercising To monitor progression Quality/Quantity motion Treatment/Coaching Exercise applications 18 papers 10 papers web application 6 papers PC workstation 3 papers phone application Providing treatment plans Virtual community/games 4 papers

Why telemedicine does not find its way towards sustainable implementation? Stephanie Jansen-Kosterink*, Rianne Huis in ’t Veld*,Karlijn Cranen* ,Hermie Hermens*# ,Miriam Vollenbroek-Hutten*#

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Roessingh Research and Development, Enschede, the Netherlands 8 200 400 600 800 1000 1200 1400 1600 8 9 10 11 12 13 14 15 16 17 18 19 Controles Uur van de dag

Gemiddelde activiteit

200 400 600 800 1000 1200 1400 1600 8 9 10 11 12 13 14 15 16 17 18 19 Controles CLBP 200 400 600 800 1000 1200 1400 1600 8 9 10 11 12 13 14 15 16 17 18 19 Controles CLBP COPD 200 400 600 800 1000 1200 1400 1600 8 9 10 11 12 13 14 15 16 17 18 19 Controls CLBP COPD CVS

  • M. Van Weering

, R. Evering , M. Tabak

Example: Activity Coaching Towards a balanced and active life

Category 3: Sensor based technology

Sensor for measuring daily activities Smartphone wireless connected with sensor and coaching engine to provide tips

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Green: reference Blue: measured activity

Category 3: Sensor based technology

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5 10 15 20 25 30 35 week 1 week 2 week 3 week 4 Numer of patients Duration of use

Compliance to activity coaching system

started completed

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Reinoud Achterkamp

Self – efficacy People with low levels

  • f self efficacy do not

change their activity pattern

ΔSelf-efficacy Success experience Vicarious feedback Verbal persuasion Physiological states

Next step: Personalized feedback

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Reinoud Achterkamp

Stage of change People in different stages

  • f change show different

problems in their activity behavior

  • Level of activity
  • Balancing activity

patterns

Next step: Personalized feedback

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Target group: Cancer survivors Blended care program:

  • Activity coaching
  • behavioral change

models

  • implemented in 9

weeks first line fysiotherapy

  • Weekly coaching by

e-mail

Marije Wolvers Fieke Everts

Next step: blended care programs

RCT with 330 patients

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Exercise-based telerehabilitation service

Category 4: Exercise applications

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  • Exercise scheme
  • Program made by therapist for each

individual patient

  • Patient logs in at home with password to own

exercise scheme (video, sproken word, text)

  • Communication via chat

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Category 4: Exercise applications

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Experience gained in clinical practice

  • Evidence gained

– European project Clear (ICT-PSP) – Dutch Project Telerevalidatie.nl

  • Implementation performed sofar

– Regional project CoCo – Dutch Project Tele-Nu

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NL Chronic pain COPD/ASTMA PL Orthopedic: Knee / hip replacement IT CVA ES TBI Dementia

800-1000 patients

(2008-2012)

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Netherlands:

(2008-2012)

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  • User satisfaction is good
  • CLEAR as partial replacement:

– As effective as conventional care

  • CLEAR as addition

– Not more effective than conventional care

CLEAR as replacement CLEAR as addition COPD

CRQ

CLBP

RDQ

COPD

CRQ

WAD

PDI

CLEAR group 62% (n=26) 63% (n=32) 77% (n=13) 42% (n=12) Control group 76% (n=21) 41% (n=34) 74% (n=23) 47% (n=19)

p=0.389 p=0.053 p=0.951 p=0.638 (2008-2012)

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  • Implementation and evaluation in 3 different rehabilitation

centres across the Netherlands in 5 different patient groups

  • Artrosis
  • Parkinsons
  • COPD
  • Astma
  • Chronic pain
  • About 100 patients are treated
  • Business models and cases are calculated to investigate

sustainable implementation using the framework developed earlier

(2011-2013)

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10 20 30 40 50 60 70 80 90 100

Chronische pijn GK

voormeting (n=12) 1ste nameting (n=12) 2e nameting (n=7) 10 20 30 40 50 60 70 80 90 100

Chronische pijn Reade

voormeting (n=4) nameting (n=4) 10 20 30 40 50 60 70 80 90 100

COPD Merem

voormeting (n=11) nameting (n=11)

10 20 30 40 50 60 70 80 90 100

Merem astma

voormeting (n=4) nameting (n=4)

 Clinical results on quality of life are positive for all diagnosis groups  Webbased exercising and teleconsultation are used most  83% of the users would advise the service to

  • ther patients

 User acceptance is high (7.7 out of 10)

(2011-2013)

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12 health care institutes in region Twente

  • Rehabilitation centre
  • Hospitals
  • Home care sector
  • 1st line physiotherapists

4 different diagnosis groups

1. Cancer rehabilitation 2. Acute hip 3. COPD 4. Chronic hip and knee problems

More than 100 patients are treated using this technology and research into sustainable implementation has been done

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(2010-2012)

Region Twente is candidate reference site within EIP-AHA

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Further development

User requirements engineering

  • Iterative approach
  • Combined framework using State of the art methodologies from
  • Computer sciences
  • Medical science

(2010-2012)

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Multimodal service platform Selfmanageme nt

Teleconsultatie Webbased oefenen Zelfmanagement Activiteiten coaching

(2010-2012)

Further development

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Different ways of implementation

Kiosk/ At HOME/ Individual setting in health care institute Individual protocol in terms of modules used, intensity and duration versus fixed protocol As follow up treatment, as partial replacement or as addition to current treatment In the health care chain or from a single health care institution

(2010-2012)

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TELEMEDICINE

FOR PATIENTS WITH COPD

New treatment approaches to improve daily activity behaviour Monique Tabak

7 februari 2014

(2010-2012)

Diagnosis Client Satisf. Questionnaire max 32, Mean (sd) Webbased exercising range (0-10), Mean (sd) Selfmanageme nt range (0-10) Mean (sd) Activity coach range (0-10) Mean (sd) % that advises positive Acute hip, Hospital 28.8 (4.4), (n=4) 8.6 (0.6), (n=3) 9 (n=2) 10 (n=1) 100% (n=4) Acute hip, nursing home Missing 7.8 (1.7), (n=12) Not relevant 92% (n=12) Arthritis 22.4 (4.4), (n=7) 6.3 (1.6), (n=6) 5.1 (1.1), (n=7) 5.4 (2.6), (n=7) 28.6% (n=7) Cancer 28.4 (3.6), (n=16) 6.1 (1.5), (n=17) 6.3 (1.5), (n=17) 5.9 (1.5), (n=17) 44% (n=9) COPD 26.3(1.3 SE), (n=12) 7.5(1.5), (n=11) 7.9 (1.3), (n=11) 6.8 (2.6), (n=12) 90% (n=10) Average 27 7.0 6.7 6.2 71%

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Diagnosis Treatment duration (average) Patients use (average %

  • f treatment

days) Professionals use (average %

  • f treatment

days) Acute hip, hospital 60 days 70% 18% Arthritis Missing Missing Missing Cancer 231 days 87% 9% COPD 256 days 79,8% 32% Use of the portal expressed in general logins by the patient and professional

(2010-2012)

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  • Implementation of the telerehabilitation modules to 10

rehabilitaton centers in the Netherlands

  • 92 health care professionals and 105 patients sofar

(2013-2014)

Teleconsultation Webbased exercising Self-management Activity Coach

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(2014-2018) Next step: Rehabilitation initiative

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Next step:

(2013-2016)

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www.perssilaa.eu

PERsonalised ICT Supported Service for Independent Living and Active Ageing “ no: 610359

Next step: Preventive personalized services

(2013-2016)

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Monitoring Screening Training Profesionally Supported care Multimodal: physical, cognitive and nutrition aspects

Next step: Preventive personalized services

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  • Second screening and

Service provision

  • together with

municipalities a

  • as self management

services First screening with general practitioners

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Development into self management programs with a personal recommender system, taking into account

  • Expert opinion
  • Patients

preferences

  • Patient goals

Hossein Nassabi

Next step: Preventive personalized services

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Physical active Cognitive stimulation Healthy nutrition Adherence to services provided Game layer Feedback and rewarding Positive influence

  • n mediators

Actual Daily functioning Performance while using the services Performance Content Timing Presentatio n Comparison in relation to individual goal and Decision Support Game layer Content Timing Presentatio n

  • Gamification layer will

be developed to improve motivation and adherence to the service

  • Gamification can be

used to involve others into the services

Frederieke de Vette

Next step: Preventive personalized services

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  • Negotiation meeting -
  • Moves out of the health care sector

into the community

  • In Twente, sport associations,

neighborhood houses etc will be used as physical place to put the services in place.

  • The region starts with enrollment of

the physical service modules at district level and will via an iterative approach broaden the implementation and validation with

  • ther services modules.

Health care sector

Next step: Preventive personalized services

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Fysio/sportscentres Home care institutions Neigbourhood houses Health care Municipalities Home

Example Enschede, same strategy in Hengelo en Tubbergen, ……….

Screening >65 year (around 3000

  • lder adults

Further Screening of pre-frail and training locations

Teaching environment for students Location for screening and training

Next step: Preventive personalized services

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Service validation starts in september

  • 350 Elderly will enroll the study and use the perssillaa services
  • First elderly will be enrolled within the first year already
  • Outcome assessment will be the same in Italy and the Netherlands and

will be performed every 3 months

  • Outcome assessment focuses on parameters like:
  • Health status
  • Every day functioning
  • Awareness
  • Satisfaction with the service
  • Risk on frailty
  • Costs
  • Sustainable business models will be developed for implementation after

the project

Next step: Preventive personalized services

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Take home messages

  • There is an increasing need for care for those with chronic

diseases

  • Telemedicine services are about to come and seem to have

potential in various health care sectors in terms of acceptance and clinical benefits

  • Implementation of telemedicine in clinical practice is not naturally
  • Future directions
  • More personalized care taking integrating behavioural state of individuals
  • Offered as blended care programs
  • Prevention / self management services with intelligent personal

recommenders

  • More motivational strategies for coaching/feedback

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