PERSONALISATION AND DYNAMISATION OF CARE PATHWAYS – FOUNDATIONS AND CONCEPTUAL CONSIDERATIONS

The transition of western health care systems can be facilitated by Integrated Care (IC) approaches helping to diminish demographic challenges. The concept of clinical pathways is an approach for a more structured, overarching and broader care as it allows higher system efficiency, i.e. a better coordination of treatment especially for patients with complex diseases (co-morbidities). They can be sustained by Information and Communication Technology (ICT) that enables a better coordination and integration of patients within their care and social network. However, there is no broad use of such pathways as it lacks of a concept for the utilisation of a holistic pathway usage for the care of people with co-morbidities. The paper contributes by developing a framework for the design, handling and work of or with personalised dynamic pathways (PDPs). By suggesting the PDP-Framework, we aim at providing a concept that has the potential to improve the care. It also fosters the application of ICT-based care in terms of a concept for shaping ICT services. Our contribution builds the fundament for a multi-actor involvement along the care processes and facilitates the monitoring of the patients’ statuses, their activities and compliance with care measures

Application of Lifetime Electronic Health Records: Are we ready yet?

Integrated care concepts can help to diminish demographic challenges. Therefore, the use of eHealth solutions is recognised as an efficient approach. Lifetime electronic health records (LEHRs) are expected to increase continuity, effectiveness, efficiency and thus quality of the care process. With respect to these benefits, an overarching implementation of LEHRs is desirable but non-existent. Hence, the aim of the article is to analyse the current LEHR implementation readiness of EU member states to derive implications for further LEHR research and development. Therefore, a case study on Denmark, Germany and Italy was conducted. The analysis shows that all countries fulfil the technical requirements but Denmark has great experiences and willingness to implement advanced eHealth measures like LEHRs. First Italian pilot projects are quite promising as well. The article paves the way for LEHR implementation and there with for integrated care

Costs and effects of telerehabilitation in neurological and cardiological diseases: A systematic review

Introduction: Telerehabilitation in neurological and cardiological diseases is an alternative rehabilitation that improves the quality of life and health conditions of patients and enhances the accessibility to health care. However, despite the reported benefits of telerehabilitation, it is necessary to study its impact on the healthcare system. Methods: The systematic review aims to investigate the costs and results of telerehabilitation in neurological and cardiological diseases. MEDLINE and EMBASE databases were searched from 2005 to 2021, for studies that assess the costs and results of telerehabilitation compared to traditional rehabilitation (center-based programs) in neurological and cardiological diseases. A narrative synthesis of results was carried out. Results: A total of 8 studies (865 participants) of 430 records were included. Three studies were related to the costs and results of telerehabilitation in neurological diseases (specifically in stroke). In total, five studies assessed telerehabilitation in cardiological diseases (chronic heart failure, coronary heart disease, acute coronary syndrome, and cardiovascular diseases). The duration of the telerehabilitation ranged from 6 to 48 weeks. The studies included cost-analysis, cost-benefit, cost-effectiveness, or cost-utility. In total, four studies found significant cost/savings per person between $565.66 and$2,352.00 (p < 0.05). In contrast, most studies found differences in costs and clinical effects between the telerehabilitation performed and the rehabilitation performed at the clinic. Just one study found quality-adjusted life years (QALY) significant differences between groups [Incremental cost-effectiveness ratio (ICER) per QALY ($-21,666.41/QALY). Discussion: Telerehabilitation is an excellent alternative to traditional center rehabilitation, which increases the accessibility to rehabilitation to more people, either due to the geographical situation of the patients or the limitations of the health systems. Telerehabilitation seems to be as clinical and cost-effective as traditional rehabilitation, even if, generally, telerehabilitation is less costly. More research is needed to evaluate health-related quality of life and cost-effectiveness in other neurological diseases.This project has received funding from the European Union's Horizon 2020 Research and Innovation Program under grant agreement no: 769807

Using Clinical Pathways To Virtual Coach Patients For Home Rehabilitation

When transitioning from the hospital to the home context, elderly patients need motivation and help to engage in rehabilitation. Prior research supposes Virtual Coaches (VCs) to keep motivated and to serve as a companion. Yet, using VCs for home rehabilitation requires various technologies (e.g., smart sensors and machine learning) and stakeholders. In this paper, we report about a case study as part of the vCare project on using clinical pathways to set the procedural precept for integrating diverse technologies and stakeholders for home rehabilitation. We contribute to design artifacts and to design knowledge. For design knowledge, we systemize requirements that help design further modeling languages for modeling clinical pathways, derive further clinical pathways, or integrate further technologies or stakeholders in supervised care. Furthermore, our design artifacts may be used to investigate research ideas of other IS domains such as gamification or anthropomorphism

Table_3_Costs and effects of telerehabilitation in neurological and cardiological diseases: A systematic review.DOC

IntroductionTelerehabilitation in neurological and cardiological diseases is an alternative rehabilitation that improves the quality of life and health conditions of patients and enhances the accessibility to health care. However, despite the reported benefits of telerehabilitation, it is necessary to study its impact on the healthcare system.MethodsThe systematic review aims to investigate the costs and results of telerehabilitation in neurological and cardiological diseases. MEDLINE and EMBASE databases were searched from 2005 to 2021, for studies that assess the costs and results of telerehabilitation compared to traditional rehabilitation (center-based programs) in neurological and cardiological diseases. A narrative synthesis of results was carried out.ResultsA total of 8 studies (865 participants) of 430 records were included. Three studies were related to the costs and results of telerehabilitation in neurological diseases (specifically in stroke). In total, five studies assessed telerehabilitation in cardiological diseases (chronic heart failure, coronary heart disease, acute coronary syndrome, and cardiovascular diseases). The duration of the telerehabilitation ranged from 6 to 48 weeks. The studies included cost-analysis, cost-benefit, cost-effectiveness, or cost-utility. In total, four studies found significant cost/savings per person between $565.66 and$2,352.00 (p DiscussionTelerehabilitation is an excellent alternative to traditional center rehabilitation, which increases the accessibility to rehabilitation to more people, either due to the geographical situation of the patients or the limitations of the health systems. Telerehabilitation seems to be as clinical and cost-effective as traditional rehabilitation, even if, generally, telerehabilitation is less costly. More research is needed to evaluate health-related quality of life and cost-effectiveness in other neurological diseases.Systematic review registration[https://figshare.com/articles/journal_ contribution/Review_Protocol_Costs_and_effects_of_Telerehabilitation_in_ Neurological_and_Cardiological_Diseases_A_Systematic_Review/19619838], identifier [19619838].</p

Table_2_Costs and effects of telerehabilitation in neurological and cardiological diseases: A systematic review.DOCX

IntroductionTelerehabilitation in neurological and cardiological diseases is an alternative rehabilitation that improves the quality of life and health conditions of patients and enhances the accessibility to health care. However, despite the reported benefits of telerehabilitation, it is necessary to study its impact on the healthcare system.MethodsThe systematic review aims to investigate the costs and results of telerehabilitation in neurological and cardiological diseases. MEDLINE and EMBASE databases were searched from 2005 to 2021, for studies that assess the costs and results of telerehabilitation compared to traditional rehabilitation (center-based programs) in neurological and cardiological diseases. A narrative synthesis of results was carried out.ResultsA total of 8 studies (865 participants) of 430 records were included. Three studies were related to the costs and results of telerehabilitation in neurological diseases (specifically in stroke). In total, five studies assessed telerehabilitation in cardiological diseases (chronic heart failure, coronary heart disease, acute coronary syndrome, and cardiovascular diseases). The duration of the telerehabilitation ranged from 6 to 48 weeks. The studies included cost-analysis, cost-benefit, cost-effectiveness, or cost-utility. In total, four studies found significant cost/savings per person between $565.66 and$2,352.00 (p DiscussionTelerehabilitation is an excellent alternative to traditional center rehabilitation, which increases the accessibility to rehabilitation to more people, either due to the geographical situation of the patients or the limitations of the health systems. Telerehabilitation seems to be as clinical and cost-effective as traditional rehabilitation, even if, generally, telerehabilitation is less costly. More research is needed to evaluate health-related quality of life and cost-effectiveness in other neurological diseases.Systematic review registration[https://figshare.com/articles/journal_ contribution/Review_Protocol_Costs_and_effects_of_Telerehabilitation_in_ Neurological_and_Cardiological_Diseases_A_Systematic_Review/19619838], identifier [19619838].</p

Table_1_Costs and effects of telerehabilitation in neurological and cardiological diseases: A systematic review.DOCX

IntroductionTelerehabilitation in neurological and cardiological diseases is an alternative rehabilitation that improves the quality of life and health conditions of patients and enhances the accessibility to health care. However, despite the reported benefits of telerehabilitation, it is necessary to study its impact on the healthcare system.MethodsThe systematic review aims to investigate the costs and results of telerehabilitation in neurological and cardiological diseases. MEDLINE and EMBASE databases were searched from 2005 to 2021, for studies that assess the costs and results of telerehabilitation compared to traditional rehabilitation (center-based programs) in neurological and cardiological diseases. A narrative synthesis of results was carried out.ResultsA total of 8 studies (865 participants) of 430 records were included. Three studies were related to the costs and results of telerehabilitation in neurological diseases (specifically in stroke). In total, five studies assessed telerehabilitation in cardiological diseases (chronic heart failure, coronary heart disease, acute coronary syndrome, and cardiovascular diseases). The duration of the telerehabilitation ranged from 6 to 48 weeks. The studies included cost-analysis, cost-benefit, cost-effectiveness, or cost-utility. In total, four studies found significant cost/savings per person between $565.66 and$2,352.00 (p DiscussionTelerehabilitation is an excellent alternative to traditional center rehabilitation, which increases the accessibility to rehabilitation to more people, either due to the geographical situation of the patients or the limitations of the health systems. Telerehabilitation seems to be as clinical and cost-effective as traditional rehabilitation, even if, generally, telerehabilitation is less costly. More research is needed to evaluate health-related quality of life and cost-effectiveness in other neurological diseases.Systematic review registration[https://figshare.com/articles/journal_ contribution/Review_Protocol_Costs_and_effects_of_Telerehabilitation_in_ Neurological_and_Cardiological_Diseases_A_Systematic_Review/19619838], identifier [19619838].</p