Enhancing quality of care through innovation uptake by all citizens and contributing to a sustainable public care services provisioning model based on predictive modelling tools.

This article was published on behalf of the authors: Rosana Angles, Innovation Consultant at Servicio Aragonés de Salud, and María Teresa Hurtado, Innovation Consultant at Servicio Aragonés de Salud.

The region of Aragón is characterised by a large heterogeneity, where parts of the region have very low population density and are depopulated, and an ageing population with one of the highest life expectancies in Europe, and with some of the highest dependency rates in the EU. Furthermore, it is an extensive, mountainous region, and with bad communications, where healthcare resources are not easily accessible by all.

This entails many challenges such as the cost burden of chronic disease management, the sustainability of quality independent living for patients and the provision of an equitable healthcare and social care systems for all.

Currently, Aragón has a target population of 1.314.586 inhabitants of which, in 2022, more than 22% of the total population was 65 years or older, 70% of which have long-term chronic conditions. Thus, ageing, chronicity and dependence are one of its strategic priorities, together with patient empowerment, and a “person-centred” healthcare and social care system based on the needs of the citizen as set forth in the Aragón Government’s Health Plan 2030 and in line with the Healthcare Digital Strategy..

Hence, Aragón’s health strategy aims to improve the quality of life by promoting that the citizen stays in his/her environment, and by bringing healthcare services to all citizens, regardless of where they live, and work and hence provide sustainability of the healthcare system and avoid depopulation.  Moreover, it aims improve dependence on the healthcare system by chronic patients to reduce the number of hospital admissions, the number of visits to emergency services,. It also intends to achieve the patient empowerment by promoting active ageing healthy lifestyles, self-management and patient empowerment via innovative ICT solutions. Moreover, Aragón will use predictive analytics to assist in decision-making, improve patient outcomes, and improve use of healthcare resources.

Aragon and Servicio Aragonés de Salud have been working with this mindset for more than 15 years and have developed, piloted and evaluated various ICT supported solutions for its achievement. In the case of Gatekeeper, the Aragón pilot focusses on treating multimorbidity chronic elderly patients with COPD, cardiovascular disease, and polypharmacy, as well COVID-19 patients who are in risk of suffering complications due to their situation, but not so critical to be admitted to hospital.  Likewise, it aims to promote healthy lifestyle habits among ≥50 year-old adults.  GATEKEEPER project in Aragón is an opportunity to evolve the chronic patient care through integrated social and health care. In this progression, automatic analysis of patient data expected to contribute to two main goals, namely, quality of life improvement and resources optimization without disparaging care continuum in the daily life of chronic patients.

The use cases that the Aragón pilot pivots around implementing care services to chronic patients using different technology (to prevent and slowdown the progression in the appearance of complications related to their pathologies and ailments and thus ameliorate the patients’ quality of life. The use cases organised around three levels of care complexity are:

  • Promotion of a Healthy lifestyle and prevention of ≥ 50 year-old adults perceptible of suffering a chronic disease: The aim is to foster active and healthy ageing by promoting physical activity, cognitive training, social participation and providing health educative material. For this purpose, a self-management app MAHA easily downloadable from Google and IOS stores is used. MAHA also provides a dashboard so that the medical staff can monitor each patient and apply preventive if necessary. 
  • Integrated care for early detection of exacerbations in chronic patients 65 or more years old with COPD, Heart Failures, or polypharmacy (5 or more drug intake) and multimorbidity. In addition, the patient may have social needs. The objective is to decrease both programmed (consultations) and not programmed (emergencies) activities, in addition to reduce admissions and hospital length of stays and improve quality of life. An individualised integrated health and social care plan is designed for each patient throughout the collaboration of all the care stakeholders. Vital-signs telemonitoring service is one of the most requested services . This service consists of periodic vital signs capturing considering the patient’s profile with electronic medical devices that send the information to a telemonitoring portal hosted in SALUD. There is a contact centre in charge of the patients’ follow-up, and more precisely, of the potential alarms that might be triggered by the vital signs measurements.
  • COVID-19 Home Monitoring is a service implemented during the crucial months of the pandemic whose objective was to reduce hospital admissions, reduce length of stays at hospital, reduce primary care activity, exacerbation prevention, and support in thedevelopment of predictive models on the COVID-19 pandemic evolution. For this purpose, vital signs telemonitoring service was implemented.
  • Integrated care for chronic patients in acute phases 65 or more years old with COPD, Heart Failures, or polypharmacy (5 or more drug intake) and multimorbidity. The final aim is to evaluate the treatment of chronic patients during their exacerbations in their own residence (elderly house, home). For this purpose, a use case is being implemented in the Cardiac Service at the Barbastro Hospital. The intervention includes patients suffering from other symptoms, amongst others: FEV (forced expiratory volume), dyspnoea, lack of response for ambulatory treatment, fast gain or loss of weight, peripheral oedema, etc. As in mid-complexity, an integrated health and care plan will be specifically adapted and continuously updated to the patient’s needs.  For this purpose, a wearable patch for monitoring vital signs is being used. This Real-time Cardiac/ECG reporting service replaces the traditional Holter with an unobtrusive wearable patch. All signs recorded are monitored closely by the doctors via a monitoring platform.

Photo: MediBioSense VitalPatch

Source: https://www.medibiosense.com/vitalpatch/

The Aragón pilot site has designed the use cases to demonstrate real-life effects of implementing digital and innovative tools to improve quality of care and contribute to the sustainability of the public care services provision system. A coordinated action under the guidance of the Health’s Department General Directorate of Digital Transformation, Innovation and User Rights (DGTIU) strategies with all stakeholders- healthcare and social care professionals, industry, academia, patients, citizens-are proving key to achieve the Gatekeeper objectives.

Servicio Aragonés de Salud leads the Aragón Pilot Site.

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