ProACT (Designing Integrated Technology Systems for ProACTive Patient Centred Care)

The ProACT project is co-ordinated by Dr John Dinsmore at the Trinity Centre for Practice and Healthcare Innovation (TCPHI), within the School of Nursing & Midwifery at Trinity College Dublin. ProACT has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 689996. ProACT targets Europe's 50 million multimorbid patients to proactively self-manage and offset the EU's annual €700 billion cost of chronic disease management. ProACT aims to develop and evaluate an ecosystem to integrate a wide variety of new and existing technologies to improve and advance home-based integrated care for older adults with multimorbidity, including associated co-morbidities. The ecosystem will connect four key care and support models central to understanding and implementing effective, continued and coordinated patient-centric care (including self-management).

These models are:

Home care (including informal care);
Hospital care;
Community and social care;
Social support networks.

Through ProACT, the Trinity Centre for Practice and Healthcare Innovation brings together a consortium of 12 academic/research institutions, small to medium enterprises (SMEs), health service providers, EU networks, and multinational corporations including two of the world’s largest ICT companies, IBM and Philips.

Background

Presently in Europe there are 50 million people living at any one time with multimorbidity (multiple chronic conditions). The cost of chronic disease management across the EU a staggering €700bn annually. Unfortunately, our healthcare systems have not been designed to effectively support people with multimorbidity. Up until now, little has been done to understand and respond to peoples’ daily experiences of trying to manage multiple conditions, including balancing multiple medications and doctors’ appointments, understanding the symptoms of their various conditions, and trying to follow different sets of advice from many different health professionals. Managing multiple health conditions at home can often feel like a burden, making it difficult to live life to the full. This has consequences for not only the person living with multimorbidity but also for the people who are responsible for their care within the home, such as loved ones and informal carers. ProACT seeks to address this problem.

Objective

ProACT aims to develop and evaluate a digital integrated care system to support older adults (65 years and over) living with multimorbidity. It uses digital health solutions to improve home-based integrated care, to support people to remain living independently in their community for as long as possible. Core to ProACT is the ability to empower people to connect with their family, healthcare, social care and community supports (e.g. formal/informal caregivers, their GP, their pharmacist) in a way best suited to their needs as they manage their conditions. Presently, ProACT is tailored for the following conditions; Diabetes, chronic heart failure, coronary heart disease and chronic obstructive pulmonary disease, or COPD. The aim is to ensure a promotion of technology as a way to empower patients to proactively manage their conditions, promoting a sense of ownership over their health and care, within their own homes.

When complete, ProACT will be the first cloud-based, digital solution of its kind in Europe to specifically support home-based integrated care and management for older adults with multimorbidity. The key innovations of ProACT that make our system unique are:

It allows for the self-management (including medication management) of multiple diseases on one single platform
Person-centred care – it allows for an older person to determine who best to include in their care network, providing a secure means to share their health and well-being data to enhance both their social connectedness and support they may receive.

Behind ProACT is an artificial intelligent learning and data analytic system which analyses each person’s use of the system over time and better guides their self-management. It has been designed from concept using the latest approaches in human behaviour change and computer interaction and developed with strong ethical, data protection and security measures in place, this includes being GDPR compliant.

Approach

ProACT adopted a co-design research approach, which ensured that design happened with and not for participants that included:

Extensive requirements gathering (124 stakeholders were identified including people living with multimorbidity (PwMs), informal and formal carers, GPs, consultants, nurses, and pharmacists), co-design workshops and usability testing with an expert panel of 60 stakeholders (consisting of PwMs, informal and formal carers, and healthcare professionals).
A 12 month proof of concept trial across EU Health systems to evaluate the technology. Living Lab facilities in Ireland and Belgium are trial sites to 120 patients and their formal and informal care networks. A European feasibility study in Italy will also assess the cultural and political determinants for adoption ProACT across 15 patients and their care networks.

ProACT also seeks to facilitate behavioural change (self-management) via ICT-AT in a patient-specific manner, therefore a behavioural change tool kit and framework are used both in the design and evaluation of the efficacy of ProACT as a behaviour change intervention.

Website & Links

Publications

Publications

Doyle., Murphy E., Kuiper J., Smith S., Hannigan C., Jacobs A., Dinsmore J. (2019) Managing Multimorbidity: Identifying Design Requirements for a Digital Self-Management Tool to Support Older Adults with Multiple Chronic Conditions, Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, CHI 19, Glasgow, 4th-9th May 2019, pp1-14 - Received commendation from CHI 2019 DOI

Smith S., Murphy E., Hannigan C., Dinsmore J., Doyle J. (2019) Supporting older people with multimorbidity: The care burden of home health-care assistants in Ireland, Home Health Care Services Quarterly, 2019, p1-15 DOI

Albert J., Fulton P., Hoogerwerf EJH., Fiordelmondo V., Dinsmore J. (2018) Developing Sustainable, Country-Specific Business Models for a Digital Healthy Aging Self-Management Innovation, ISPIM Connects, Fukuoka, Japan, 2-5 December, pp1-16 URL

Doyle J., Murphy E., Hannigan C., Smith S., Bettencourt Silva J., Dinsmore J. (2018) Designing Digital Goal Support Systems for Multimorbidity Self-Management - Insights from Older Adults and their Care Network, Pervasive Health, New York, United States, 21st-24th May, 2018

Doyle, J., Murphy. E., Smith. S., Hannigan, C., Kuiper, J., Jacobs, A., & Dinsmore, J. (2017). Addressing medication management for older people with multimorbidities: a multi-stakeholder approach. In Proceedings of the 11th EAI International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth '17). ACM, New York, NY, USA, 78-87. DOI

Doyle J., Hoogerwerf E., Kuiper J., Desideri L., Fiordelmondo V., Hannigan C., Jacobs A., Maluccelli L., Murphy E., Smith S. (2017). Needs and Requirements of older people with multiple chronic conditions to self-manage their health. ProACT Deliverable 1.3. PDF

Murphy, E., Doyle, J., Hannigan, C., Smith, S., & Dinsmore, J. (2017). Perceptions and Use of Technology to Support Self-management for Older Adults Living with Multiple Health Conditions within a Care Ecosystem. Age and Ageing, 46(Suppl_3), iii13–iii59. DOI

Salvatore Tedesco, John Barton, & Brendan O’Flynn. (2017). A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry. Sensors, 17(6), 1277. DOI

For further publications, visit our website EC Approved Outputs (including peer-reviewed public reports)