Helen Schonenberg

Proposals for enhanced health risk assessment and stratification in an integrated care scenario.

Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. Settings The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Participants Responsible teams for regional data management in the five ACT regions. Primary and secondary outcome measures We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. Results There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. Conclusions The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require prospective evaluation.

The Declare Service

The Declare Service is a YAWL Custom Service that enables decomposing YAWL tasks into DECLARE workflows, that is, workflows supported by the workflow management system (WfMS) called DECLARE. The goal of this service is to enable a particular kind of flexibility. Chapter 6 describes a constraint-based approach to workflow models and the ConDec language. This approach, supported by the DECLARE WfMS, allows for more flexibility, that is, execution of tasks is allowed if it is not explicitly forbidden by some constraint. This chapter describes DECLARE and the Declare Service for YAWL. Sometimes it is easier to express a process in a procedural language (e.g., the native workflow language of YAWL) and sometimes a declarative approach is more suitable. Moreover, in a larger process it may be useful to express parts of the process in a procedural language and specify other parts in terms of constraints. Using the service-oriented architecture of YAWL, this can easily be realized. A YAWL task may decompose into a DECLARE process and a task in DECLARE can be decomposed into a YAWL process. Arbitrary decompositions of DECLARE and YAWL models allow for the integration of declarative and YAWL workflows on different abstraction levels.1 This way the designer is not forced to make a binary choice between a declarative and a procedural way of modeling. Hence, a seamless integration can be achieved, where parts of the workflow that need a high degree of flexibility are supported by declarative DECLARE models, and parts of the processes that need centralized control of the system are supported by YAWL models.

Telehealth for patients with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis protocol

Introduction Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease characterised by persistent respiratory symptoms. A focus of COPD interventional studies is directed towards prevention of exacerbations leading to hospital readmissions. Telehealth as a method of remote patient monitoring and care delivery may be implemented to reduce hospital readmissions and improve self-management of disease. Prior reviews have not systematically assessed the efficacies of various telehealth functionalities in patients with COPD at different stages of disease severity. We aim to evaluate which COPD telehealth interventions, classified by their functionalities, are most effective in improving patient with COPD management measured by both clinical and resource utilisation outcomes. Methods and analysis We will conduct a systematic review which will include randomised controlled trials comparing the efficacy of telehealth interventions versus standard care in patients with COPD with confirmed disease severity based on forced expiratory volume(%) levels. An electronic search strategy will be used to identify trials published since 2000 in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINHAL. Telehealth is described as remote monitoring and delivery of care where patient data/clinical information is routinely or continuously collected and/or processed, presented to the patient and transferred to a clinical care institution for feedback, triage and intervention by a clinical specialist. Two authors will independently screen articles for inclusion, assess risk of bias and extract data. We will merge studies into a meta-analysis if the interventions, technologies, participants and underlying clinical questions are homogeneous enough. We will use a random-effects model, as we expect some heterogeneity between interventions. In cases where a meta-analysis is not possible, we will synthesise findings narratively. We will assess the quality of the evidence for the main outcomes using GRADE. Ethics and Dissemination Research ethics approval is not required. The findings will be disseminated through publication in a peer-reviewed journal. PROSPERO registration number CRD42018083671.

A data model to support the evaluation of coordinating care EU programmes in the context of the ACT programme

Advancing Care Coordination and Telehealth Deployment (ACT) is a European Union (EU) project, completed last October, which has developed a framework for evaluating and improving pioneering health care programs regarding coordinating care and telehealth (CC & TH) across specific EU regions. In this paper we present the key design decisions of the projects data model and the challenges faced. We focus on the definition of the multi-dimensional indicators in order to overcome data incompleteness and heterogeneity issues. Finally, we also suggest a graph based approach that could facilitate development of such data models in similar projects.

Evaluating Care Coordination and Telehealth Services across Europe through the ACT Programme

This paper presents the main concepts and ideas of the research program ACT (Advancing Care Coordination & TeleHealth Deployment). ACT focuses on studying Coordinated Care (CC) and TeleHealth (TH) services for chronically ill patients, such as heart failure, COPD, diabetes, as well as co-morbid patients. The potential of these services to improve quality of care within European healthcare systems can be fully released only when certain barriers are overcome and organizational changes progress. Therefore, the purpose of ACT, as described in this work, is to study in a qualitative and quantitative manner, with a solid and reproducible research methodology, the organizational and structural procedures supporting effective implementation of CC&TH services in the routine management of chronic patients. The consortium will investigate key organizational and structural drivers in 5 European healthcare regions, and eventually produce a toolkit for use across Europe