What is the ProACT Project?
ProACT (Integrated Technology Ecosystems for ProACTtive Patient Centred Care) is a highly ambitious digital health research programme that aims to develop and evaluate a digital integrated care system to support older adults living with multimorbidity (multiple chronic conditions), with a focus on diabetes, chronic heart disease/failure, COPD, and mild cognitive impairment.
The Problem / Challenge
- There are approximately 50 million patients in Europe with multimorbidity (two or more chronic conditions)
- The cost of chronic disease management in the EU is €700 billion per annum
- 70-80% of healthcare costs are spent on chronic diseases
- The four main types of chronic diseases are cardiovascular disease (e.g. chronic heart failure), cancers, chronic respiratory diseases (e.g. COPD) and diabetes; ProACT will initially target chronic heart disease/failure, COPD and diabetes, along with mild cognitive impairment
- Most models of care across the EU focus on a single disease approach, and are not adaptive to the needs of patients with multiple chronic conditions
- Care for patients with multimorbidity is frequently repetitive (multiple appointments), inconvenient, inefficient, confusing (e.g. conflicting advice from different clinicians), burdensome, and potentially unsafe due to poorly integrated and coordinated care (e.g. medication interactions)
- Poorly integrated and coordinated care for multimorbidity has a range of negative consequences for the health and quality of life of the patient and their carers, but also at a broader societal level due to the high burden placed on financial, healthcare, and human resources by multimorbidity and chronic disease
- There is a need to improve best practice around the provision of well-coordinated, person-centred care for individuals with mutlimorbidity
- Another key challenge is to empower both the patient with multimorbidity and their primary informal carers to play an active role in self-management and care practices
A Potential Solution: ProACT
- ProACT will use digital health solutions to improve home-based integrated care, and to support older adults (aged 65+) with multimorbidity to remain living independently in their community for as long as possible
- The project will develop and evaluate an ICT-AT ecosystem (information and communications technology and assistive technology) to help coordinate and support multimorbid disease management, including self-management
- The ProACT system aims to provide a unified approach to integrated care, centred on the patient at home supported by key actors (informal caregivers, formal/social care workers, community based clinicians, pharmacists and hospital based clinicians)
- Initially the system will be designed to target integrated care for diabetes, chronic heart failure, COPD and mild cognitive impairment
- The ProACT system has the potential to be further developed to address all chronic disease groups across all age groups.
- A range of new and existing care applications, sensors and healthcare technology devices will be linked to the ProACT system. Customised interfaces will allow patients, informal carers, and other key support actors (e.g. GPs, pharmacists, hospital based clinicians) to access the system via their tablet, smartphone or computer, in order to input and access relevant information for the support of home-based, digital, integrated healthcare.
ProACT aims to:
- Improve patient engagement by using the system to empower the patient to proactively manage their multimorbid conditions and to promote a sense of ownership over their health and their care
- Improve workflow management to optimise and improve the effectiveness of services and care delivery for patients with multimorbidity, by linking different organisational structures and healthcare teams (e.g. GP, hospital-based clinicians, specialist consultants and teams, pharmacists) and providing training applications to support key actors in the patients’ care network
- Advance new healthcare models that are flexible, patient-centric rather than single-disease specific
- Advance home-based healthcare and use of ICT-AT for management of multimorbidity
ProACT Project and Consortium
- The project was awarded €4.87 million by the European Commission under the Horizon 2020 Framework
- The landmark project, coordinated by Dr John Dinsmore in Trinity College Dublin, involves 12 partners across 6 EU Member states (Ireland, United Kingdom, Belgium, Austria, Spain and Italy).
- ProACT brings together a consortium of 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)
- The project will take place over 42 months (January 2016 – July 2019)
ProACT will address 7 core objectives across 8 work packages, over a 42-month period. These are:
To develop an integrated, responsive, decision support information and communications technology and assistive technology (ICT-AT) care ecosystem to help co-ordinate and support multi/comorbid disease management (including self-management).
To implement a core suite of effective ICT-AT to track and provide personalised 'clinical and non-clinical' feedback to individuals living with multi/comorbidities that inform, educate and support health and well-being self management.
To advance 'big data' and cloud platform integration, mining and analysis techniques to assist in the development of new models of multi/comorbidity integrated care.
To validate a behavioural change assessment ‘tool kit’ and framework to support the sustainability and scalability of the ProACT ecosystem.
To deploy an innovative user-driven ‘proof of concept’ ProACT ecosystem trial in 2 EU sites (Belgium and Ireland).
To conduct an EU-wide feasibility study (including less well developed regions) to assess the transferability of the ProACT system across member states.
To develop a clear exploitation plan and implementation strategy for intellectual property created from ProACT (WP6). This will include clear financial, business and commercial strategies for sustaining and scaling the ProACT ecosystem at EU and international levels. The plan will establish a post-programme impact committee to assess outputs up to two years post project completion (WP7).
Structure of ProACT Project
Work Package 1
This is the requirements gathering phase, which will involve a detailed mapping of the ecosystem, using desk, qualitative and ethnographic research methods. Outcomes will be used to define care pathways associated with the multimorbidity patients as well as examine key factors that impact on QoL and well-being. Key stakeholder and actor relationships will be mapped to understanding the factors within the home that affect the quality of care and quality of life (QoL) of both patient and informal carer. The primary output will be a trial strategic plan for the implementation of ProACT.
Work Package 2
ProACT Ecosystem ICT-AT Development
This Work Package focuses on the design and development of the suite of supportive ICT-AT data aggregation platform and training tools for multimorbid patients and key support actors. Development of the technology will use an iterative, co-creation, user centred design and development process. Technologies will be tested initially in the pilot trial and then in the Proof of Concept trial in all test bed regions.
Work Package 3
Data Representation, Comparability, Interchange and Analytics
This Work Package will provide an innovative data analytics framework for the ecosystem. The main output will be the development of the InterACT Cloud platform to create integrated and extensible models of understanding of patient behaviour and interactions with support actors to aid adoption of the ICT-AT. An important aspect to this WP is the investigation of the privacy features for ICT-AT culminating in a whitepaper on the system and associated privacy issues.
Work Package 4
Developing a Behavioural Change Assessment Kit and Framework
This Work Package will establish factors that facilitate behavioural change within the ecosystem. Outputs from WP1 will link in with WP4 to understand the ecosystem. Positive behavioural change is important for patients to adopt new lifestyle practices to improve health and QoL. The primary outcomes will be a behavioural change tool kit and framework to help inform stakeholders of best practices to facilitate behavioural changes via ICT-AT use within the ecosystem.
Work Package 5
Trial Implementation and Evaluation
This Work Package is split into 3 trials (i) Test or pilot trial (ii) Main PoC Trial and (iii) Transfer feasibility trial. Trials will be informed by outcomes of WP1-4 with evaluation periods proceeding trials. The transfer feasibility trial will run in parallel to the main trial. PoC trials (Ireland & Belgium) will be based on 3 action research and iterative design and development cycles over 12 months.
Work Package 6
Dissemination, Exploitation, Communication and Commercialisation
Key outcomes of this Work Package will be to develop the health economic, commercial and business development models to support exploitation, sustainability and scalability of the ecosystem at EU and International levels. To support this we will develop a pan-European survey on integrated care and ICT-AT for multimorbidity care.
Work Package 7
Project Coordination and Management
This Work Package will cover the overall coordination and management of the programme, including the set up of management, steering committee and advisory board structures and establishment of the legal, ethical and regulatory frameworks to conduct the overall work plan.
Work Package 8
This Work Package will deal with all ethical requirements arising in the ProACT project.