Abstract
The current study analyzes the information collected and the lessons learned during the first six months of the CONNECARE project in Israel, in order to assess the use of the mobile technology by patients, their motivations and obstacles; as well as their satisfaction. As of the middle of February 2019, 59 patients were recruited and 18 discharged from the project and completed the feedback questionnaires. Based on preliminary data presented in this chapter, as measured against the McGaughey et al. Research Framework, it can be concluded that the usage of the CONNECARE mobile platform can be rated as moderate. The analysis together with insights from the literature, suggest that usage of the CONNECARE app could be improved by introducing additional features that would increase patients' motivation to use the system as well as its full integration into usual healthcare processes.
TopIntroduction
The use of mobile apps by the elderly is receiving increasing attention and there are an increasing number of apps on the market targeting this populations, particularly in the area of health care. These include apps for monitoring such as iBP Blood Pressure and Instant Heart Rate: Heart Rate and Pulse Monitor; provision of medical health care advice such as My Medical, WebMD and AskMD; and medication reminders such as Pill Reminder Pro, Pillboxie, MedCoach, and MediSafe (Hurst, 2018; iYogi, 2018). These apps are intended to be used by the patient for self-care at home. Several studies have investigated motivation as well as design issues. Among these, there is a growing conviction and preliminary evidence that mobile apps can support chronic disease management (Quinn et al., 2011; Bexelius et al., 2010; Carrasco et al., 2008; Lester et al., 2010). However, chronic disease management (CDM) apps have not lived up to their potential because relatively few patients are willing to pay for the digital tools. Huckman and Stern maintain that the more likely customers are health care organizations (Huckman & Stern, 2018). Despite this, there have been relatively fewer studies done specifically on the use of mobile apps by complex chronically ill older adults within an organizational based -integrated health care setting as an aid to treatment adherence, self-management and interaction with healthcare professionals. CONNECARE, a project funded by the European Commission’s HORIZON 2020 program, is currently being conducted in Ashdod, Israel by Samson Assuta Ashdod Hospital and Maccabi Healthcare Services. The project focuses on digitally enabled integrated care for complex, chronically ill older adults. The digital platform being comprises a mobile app accompanied by a wearable device for the patients that is interfaced with a computerized case management platform operated by the health professionals.
The purpose of this chapter is to analyze the information collected and the lessons learned during the course of the CONNECARE project to date, in order to: assess the use of the mobile technology by the patients in the project in Israel including their motivations and obstacles as well as satisfaction; its effects on patient – healthcare professional interaction; and, the extent to which the use of the mobile technology contributed to patient empowerment and self-management, patient quality of life and care integration. The McGaughey, Zeltman, and McMurtey (2013) research framework was used to guide analysis in this study. It delineates the relationships between motivation, obstacles, ease of use, adoption and actual usage. The objective was to better understand the best use of mobile technology for the elderly in a healthcare setting, address all factors in our research model, and investigate implications related to appropriate technology design for this population.
Key Terms in this Chapter
Case Management: A collaborative process of assessment, planning and care coordination to meet an individual's comprehensive healthcare needs coordinated by a designated case manager – in the case of CONNECARE in Israel, by nurse case managers.
Digital Single Market: A policy belonging to the European Single market that covers digital marketing, e-commerce and telecommunications. It is a part of the Digital Agenda for Europe 2020 as defined in the document A Digital Single Market for Europe by the European Commission published in May 2015.
AAL (Ambient Assisted Living Program): A funding program that works towards creating market-ready products and services for older people, co-financed by the European Commission (through HORIZON 2020) and 17 countries.
HORIZON 2020 Program: The HORIZON 2020 program is the 8 th iteration of the European Framework Program for Research and Innovation that is financed and operated by the European Commission and provides grants to proposals responding to published calls from 2014-2020.
CONNECARE: Acronym for “Personalised Connected Care for Complex Chronic Patients” the formal name of the project funded by a grant from the European Commission.
Maccabi Integrated Care Unit: This unit is operated by Maccabi and physically situated in Samson Assuta Ashdod Hospital. Its purpose is to do joint discharge planning with hospital staff for Maccabi patients and to assure a seamless transition back to the community by coordinating the services required by the patient in the community post discharge.
Electronic medical records (EMRs): Digital versions of patient charts in clinician offices, clinics, health plans and hospitals, mostly used for diagnosis and treatment in this chapter. Used interchangeably with electronic health records that contain information from most or all clinicians involved in the patient's care, at least within a given sector such as a community network or a hospital.
Implementation Research: An integrated concept that links research and practice in order to improve the implementation of health policies, programs and practices. It is multidisciplinary and focuses on practical approaches to improve implementation and to enhance equity, efficiency, scale-up, sustainability and ultimately, to improve people's health.
Maccabi Healthcare Services: The second largest Health Fund in Israel covering 25% of the population (more than 2 million people) responsible for covering and providing all of the services in the public basket of services under the Israel National Health Insurance Law.
Samson Assuta Ashdod Hospital: The newest public general hospital to be built in Israel – the first after 40 years – in the city of Ashdod, Israel's fifth largest city. The hospital opened its doors in 2017 and aims to be a hub for integrated care, working cooperatively with Israel's four Health Funds and Social Services.
Digitally Enabled Integrated Care: Integrated health and social care that coordinate the care for a patient among the various sectors – hospital, primary care, specialist care and social services supported by digital technologies such as electronic medical/health records, case management platforms, patient portals, mobile technology, etc.
Elective Surgery: Surgery that is scheduled in advance because it does not involve a medical emergency.