Descripción del proyecto
Un enfoque centrado en el paciente para la multimorbilidad
El envejecimiento de la población ha dado lugar a un mayor número de pacientes crónicos con una compleja multimorbilidad y que requieren atención médica. Por consiguiente, la medicina moderna debe adoptar una nueva actitud centrada en el paciente para buscar opciones terapéuticas más eficaces, así como para reducir los costes y mejorar la toma de decisiones. El proyecto financiado con fondos europeos GERONTE combinará los conocimientos especializados sobre transformación digital del sector sanitario público y privado para aprovechar los beneficios de la tecnología digital y mejorar los resultados sanitarios en pacientes de edad avanzada con enfermedades concomitantes. A partir del modelo del tratamiento pluridisciplinario del cáncer, diseñará junto con pacientes, cuidadores y profesionales un método adaptado al paciente que facilitará las vías de la atención sanitaria y las decisiones de gestión y tratamiento a la vez que se reducen los costes sanitarios.
Objetivo
Population is aging and the number of complex multimorbid patients to manage will increase sharply. Disease-centred approach is not appropriate to manage these patients. Change to a patient-centred approach will simplify care pathways, secure management and treatment decision making and decrease healthcare costs. It will be a real breakthrough for daily practice with multiple impacts that must be quantified. GERONTE multimorbid patient-centred system proposes:
1) Coordination of management by a patient-tailored, interdisciplinary health professional consortium (HPC), including hospital- and home-based professionals, with a case manager;
2) Timely registration of symptoms and patient-reported outcomes at home through a web-based app for anticipation of avoidable adverse events;
3) Proposal of self-management guidelines according to intrinsic capacity evaluation by geriatrician for patient-driven improvement of independent living;
4) Structured collection of data from electronic health record into a dashboard made available to HPC members as well as patient and caregiver, thanks to its capacity to securely interoperate with all electronic health records including software managing medical data.
The whole approach will be co-designed with patients, informal care givers and health professionals.
Cancer is an excellent model to develop this approach in multimorbid patients because it is frequent and commonly associated with other morbidities in older patients but also because of its major impact on patients’ general status and coexistent diseases. Cancer already benefits from a multidisciplinary management model that GERONTE will enhance, strengthening exchange of holistic data, role of primary care and case management.
GERONTE will also provide new country-specific guidelines and best practices for implementation across Europe and for improved management of older multimorbid patients including improved quality of life and independent living at decreased costs.
Ámbito científico
Palabras clave
Programa(s)
Tema(s)
Convocatoria de propuestas
Consulte otros proyectos de esta convocatoriaConvocatoria de subcontratación
H2020-SC1-2020-Two-Stage-RTD
Régimen de financiación
RIA - Research and Innovation actionCoordinador
33000 Bordeaux
Francia