Digital tools support value-based integrated care for older people
In 2019, globally the number of people 65 years old or over was estimated at 703 million, and is forecast to double by 2050. While this reflects improved healthcare and social development, ageing brings increased risk of chronic conditions, frailty and cognitive impairment. “These multifaceted conditions not only impact older people’s independence and quality of life, but strain healthcare systems as they provide more continuous complex care,” says Hein Raat, coordinator of the EU-supported VALUECARE project. With care often delivered by multiple specialists, VALUECARE set out to develop an integrated value-based approach, leveraging digital tools for more predictive and personalised care.
Assessing quality of life, needs and preferences
Older people often visit various locations to receive care, including outpatient units, specialty clinics and hospitals. This fragmentation can be bewildering for patients, as well as comprising care continuity. VALUECARE’s integrated care approach – seeking to link and coordinate services – was designed, implemented and evaluated with the participation of patients and professionals, guided by two recent innovations. “Firstly, rather than being focused on inputs, we looked at ‘value-based’ care outputs. Secondly, we adopted digital solutions, not to replace face-to face care but to personalise it,” explains Raat. This digital solution consisted of: a patient app, a dashboard (outlining the patient’s medical information and care pathways) and a ‘virtual coach’ (a chatbot hosted in the app). The app reminds users to do things such as take medication, as well as offering advice about healthy lifestyles. The dashboard lets professionals assign users modules and goals, and track progress. VALUECARE ran seven European pilots, targeting different populations: Rotterdam (Netherlands) focused on stroke; Rijeka (Croatia) on myocardial infarction; Athens (Greece) on Type 2 diabetes and hypertension; Treviso (Italy) on early cognitive decline; Coimbra (Portugal) on frailty and loneliness; and Valencia (Spain), alongside Cork and Kerry, and Dublin (Ireland) on frailty. Participants received group-training sessions on using the technology, augmented by online instructions. “After a 1-year follow-up, participants in all pilot intervention groups were significantly more independent, measured by ‘activities of daily living’ and by the ‘mobility score’. In some cases, such as Coimbra intervention ‘physical health’ improved, in others like Athens ‘frailty levels’ reduced, whereas in Cork there was a reduction in malnutrition levels,” notes Raat. With these positive healthcare results recorded at subsequent follow-ups, VALUECARE also evidenced reduced healthcare costs. “After a 1-year follow-up, we estimated a mean saving across all pilots of EUR 67 per intervention group participant, compared to a mean extra cost of EUR 189 per control group participant.”
Scaling VALUECARE puts patients at the centre of care
VALUECARE has demonstrated that integrated care for older people, supported by technology, is not only implementable in EU countries with different care systems, but appreciated by patients and care providers, alike. “We demonstrated how ‘value-based care’ considers quality of life, preferences and needs, while sharing decisions about care pathways and monitoring whether values are really being respected,” adds Raat. A key project legacy is a value-based healthcare course. Run twice during the project, the course was established with the help of the Value-Based Health Care Center Europe and The Decision Group. Delivered by project partners, the course offers ‘Green Belt’ certification to care professionals, ICT managers and policymakers. The team is seeking further funding to scale up the VALUECARE approach. “As positive results were not seen for all outcomes everywhere, we need further study with more participants, especially care professionals,” concludes Raat.
Keywords
VALUECARE, older people, integrated care, digital tools, health, medication, frailty, ageing, cognitive impairment