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Project

Digitized evidence based transmural care programs in a network between primary care and hospital: impact on quality of care and patient experience

Present healthcare is characterized by patients with multiple and chronic conditions, due to aging and medical technological evolutions. Another increasing trend in healthcare is short-term hospitalization (32% of all admissions in secondary care in 2014) (Agentschap Zorg en Gezondheid. n.d.).
Patients nowadays are frequent users of hospitals, primary care and even increasingly self-care (Allen, Hutchinson & Brown, 2017). This generates care transitions. Care transitions that provide safe and timely transfers of patients, between different levels of care and across different settings, are thus essential. This also applies to their data (Allen et al., 2017; Choi, 2017). In reality, patient safety and quality of care often becomes compromised in these care transitions (De Regge, De Pourcq, Meijboom, Trybou, Mortier & Eeckloo, 2017;Sadoughi, Nasiri, Ahmadi, 2018).

To ensure the follow-up of care transition after a contact (ambulatory or admission) in secondary care, PROM/PREM measurements can be implemented (Federaal kenniscentrum voor de gezondheidszorg, 2018). In a transmural setting, it offers the opportunity to better follow up the patient  and respond to unexpected outcomes, alerts and experiences. Hence, the care process can be adjusted timely, which benefits the quality of care and the patient's experience (Mooney, Berry, Whisenant & Sjoberg, 2017). Only a few randomised controlled studies were done in a non-oncological setting. PROM/PREM studies that take into account the full transmural pathway of a patient, by this reflecting real life conditions, are rarely found. A consequence of this evidence gap is a lack of instruments and appropriate measures to identify transmural outcomes and patient experiences. A second concern is the fact that most of the PREM instruments consist mainly of service related questions. These types of questions in general have little use in the adjustment of the individual care processes (micro-level: the individual patient).

Data-sharing and communication is crucial for safe care transitions. Research shows that efficient and correct data sharing and communication leads to a good quality of care with more patient involvement (sadoughi), better reconciliation of medication (Kripalani, LeFevre, Phillips, Williams, Basaviah & Baker, 2007) and higher satisfaction of the patient and caregiver (Kripalani et al., 2007; Recinos, Dunphy, Thompson, Schuschu, Urchek & Katzan, 2017). In our Belgian health care system this is a major challenge. The interoperability between the electronic systems of the different healthcare actors is missing today. This interoperability is essential to respond to challenges in healthcare with regard to efficient and patient-safe care and to real patient participation in their care process. In addition, this interoperability ensures continuity of care: all health professionals, around the patient, have access to all information (Bouamrane & Tao,  2015). The on-the-spot use of patient data and linked evidence can therefore be considered as innovative in the Belgian context and in line with technological developments in other sectors. Theoretically, this is already possible from a technical point of view.

By building bridges between currently used digital tools, a greater interoperability between different systems and services can occur. If we thereby can combine specific digital tools or methods such as telemonitoring, PROM and PREM measurement, decision support, existing eHealth facilities, ... These tools will add value to the new digital care processes in order to be able to work patient-centered and to improve patient outcome and experience.

This study will create a 'platform' to enable integrated transmural care including digital patient participation. Through this platform, information will be exchanged between the patient and his professional healthcare providers, but also between healthcare providers of the primary and secondary care. An EFRO-funded project will facilitate the technical development of interoperability between the various systems in the first, developmental part of the project. The aforementioned interoperability between the various existing applications is a conditio sine qua non for this platform.

Date:1 Jan 2019 →  30 Jun 2022
Keywords:digitalisation
Disciplines:Health information systems of medical informatics
Project type:PhD project