Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case

Abstract

Introduction:The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016-2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilitate site transferability.Methods: An implementation research approach with a population-based orientation, combining experience-based co-design and quality improvement methodologies, was applied. We undertook several design-thinking sessions (Oct-Nov 2017, June 2021 and December 2021) to generate and follow-up a work plan fostering service scalability. The implementation process was assessed using the Comprehensive Framework for Implementation Research, leading to the identification of key performance indicators.Discussion: Personalization and modularity of the intervention according to patients' surgical risk were identified as core traits to enhance patients' adherence and value generation. A digitally enabled service workflow, with an adaptive and collaborative case management approach, should combine face-to-face and remotely supervised sessions with intelligent systems for patients' and professionals' decision support. The business model envisages operational costs financed by savings generated by the service. Conclusions:Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability. RESUMIntroducció: La bretxa eficàcia-efectivitat limita l'adopció de serveis d'atenció integrada amb suport digital. L'estudi descriu el procés de co-creació efectuat (2016-2021) per desplegar, a l'Hospital Clínic de Barcelona, un servei de prehabilitació de pacients de risc per a procediments quirúrgics, amb l'objectiu d'aconseguir una adopció sostenible del servei i facilitar-ne la transferibilitat.

The Assessment of Medical Device Software Supporting Health Care Services for Chronic Patients in a Tertiary Hospital: Overarching Study

“…Cocreation and quality improvement methodologies reported previously [ 20 ] were used to consolidate a pragmatic assessment protocol that was applied in the 4 digital health prototypes supporting the interventions (studies 1-4) described below.…”

“…As a result of the experience-based cocreation process [ 20 ], 4 domains of digital health system validation ( Table 2 ) and 3 eHealth contextual strategies ( Table 3 ) were considered essential for the assessment of digital health tools. Therefore, they were used to guide a thematic analysis on the assessment results of the 4 digital health interventions, by the author EB, as well as on the overview of the MDSW current regulations and the analysis of MDSW recalls of the past 5 years (2017-2021) in the European Union and the United States, by the author HWH.…”

“…The main objective of this research was to generate recommendations and to report lessons learnt from separate assessments of MDSW with the aim of bringing together the premarket experience from the cocreation of digital health interventions at the Hospital Clinic de Barcelona (HCB) during the period 2017-2019 [ 20 ] and the postmarket experience of MDSW after regulatory compliance in the European Union and the United States through MDSW recalls during the past 5 years (2017-2021). Due to the proliferation of innovation projects involving digital health interventions, there is a clear need for concerted efforts to harmonize and learn from both premarket piloting and postmarket surveillance experiences to foster applicability and standardization of the assessment of digital health tools in real-life settings.…”

“…It is of note that the premarket co-design experiences from the HCB [ 20 ] benefited from the combined input of all the stakeholders, including end users, aiming to prevent failures when reaching the market, and that the HCB has a dual role as a university center and as a driver of large community-based integrated care in the city of Barcelona (Área Integral de Salud de Barcelona Esquerra [AISBE]; 520,000 citizens) [ 21 , 22 ], falling within the activities of the Catalan Open Innovation Hub on Digitally Enabled Integrated Care Services, which is 1 of the 4 original EU Good Practices in the European Joint Action JADECARE [ 23 ].…”

Perioperative Nursing as the Guiding Thread of a Prehabilitation Program

“…Prehabilitation programs should be designed from a multidimensional approach taking into account all stakeholders involved (healthcare professionals, patients, and providers). An implementation research approach, combining experience-based co-design and quality improvement methodologies, was recently conducted at Hospital Clinic de Barcelona [ 14 ]. As part of the co-creation process, we undertook two design-thinking events (October–November 2017 and June 2021) to generate a work plan fostering service scalability with a population-based orientation.…”