A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study

Abstract

Background Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. Objective The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. Methods From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). Results In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients’ empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Conclusions Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. Trial Registration ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663

Protocol for the Enhanced Management of Multimorbid Patients with Chronic Pulmonary Diseases: Role of Indoor Air Quality

“…The baseline evaluation and follow-up of the participants includes an assessment of their digital literacy such that the study protocol considers the following three modalities of patients’ participation in terms of technological support, namely: i) phone-based only, ii) phone-based and passive use of the Beat One watch sensor 44 , and iii) digital support for patients and health professionals provided by the Health Circuit platform 20 . Each category involves a different interaction modality with the nurse case manager 45,46 , who will interface between the patient and the corresponding primary care physician (for all patients) and/or specialist (only for severe asthma patients), as delineated in Figure 2.…”

“…The pilot study 20 on community-based management of complex chronic patients with high risk for hospitalisation showed the potential of the ACM approach to enhance the management of unplanned health events. This would lead to less use of health care resources and improved patient empowerment for self-management and perception of continuity of care 53,54 .…”

“…The current study has a twofold aim. The first two PDSA cycles will contribute to refining the digital tool’s current functionalities, as shown in Figure 2 and 20 . Secondly, it will evaluate the potential of a set of short questions answered using a Likert scale, to capture patient-reported outcomes (PROMs) and patient-reported experiences (PREMs).…”

“…At the end of the first year (2024), the aim is to define the specifics of the novel service through the articulation of its four main components: i) Enhanced lung function testing through oscillometry 19 , ii) Continuous monitoring of indoor air quality (IAQ) as potential triggering factor 9–11 , iii) Digital support with an adaptive case management approach 20 , and iv) Predictive modelling for early identification and management of exacerbations.…”

Toward Sustainable Adoption of Integrated Care for Prevention of Unplanned Hospitalizations: A Qualitative Analysis

“…The second report outlines the ongoing digital health strategies for 2021–2025 [ 22 ], specifically focusing on implementing a knowledge-based digital platform to support cloud-based health services. Moreover, the description of specific digital developments [ 21 ] providing support to collaborative adaptive case management across healthcare providers, currently used for peri-surgical care (prehabilitation), was also considered in the qualitative analysis.…”