[Development of an app to support in-home care consultation visits]. / Entwicklung einer App zur Unterstützung häuslicher Pflegeberatungsbesuche.

BACKGROUND: The in-home care consultation visits according to § 37.3 of the Social Security Statute Book XI have been carried out inconsistently so far and with a lack of structured care documentation. In the INGE-integrate4care project, an app was developed to support the quality assurance of visits. METHOD: Based on a user-centered design approach, 10 semistructured expert interviews were conducted and analyzed using qualitative content analysis according to Mayring. In group-based expert walkthroughs with 7 participants, the design, contents and functions of the app were discussed, requirements were collected in feedback lists and digitally implemented by developers. RESULTS: Interviewees reported that visits are heterogeneous, that there are individual approaches and that this should be reflected in the design of the app. Important topics for the app were, e.g. contents of the NBA and the burden on caregivers. Functions such as the recommendation of measures on the basis of documented information are desirable. On the other hand, too stringent guidelines of the app would be an obstacle, as these would limit the conversational character of the visit. The NBA and BIZA­D were chosen by the experts in the project as suitable basic assessments and adapted to the visits. Flexible access to items, visualization of care status per category, and the ability to select and track measures were specified to support workflow. DISCUSSION: The user-centered design approach enabled the development of an app that is characterized by both flexibility and structure. The tool will be further optimized with the help of usability evaluations and focus groups.

CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia.

CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.

The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment-experiences of patients and clinicians.

BACKGROUND: Multimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes. METHODS: The Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients' management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform's applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data. RESULTS: Thirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform "overall" as 2.3 (1.1) (mean (SD), Likert scales 1-6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients' visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients' diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications). CONCLUSION: Comprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians' and patients' knowledge of the disease status and comorbidities as well as patients' management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients' outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible. TRIAL REGISTRATION: DRKS-German Clinical Trials Register, DRKS00013637 , prospectively registered. 17 January 2018.