pHealth - The co-producer model

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  • 1. The Citizen as Co-producer of Health Outline of the Service Model and The Information Model for Chronic Diseases Niels Boye University of Aarhus, Denmark and The PREVE FP7-Support Action: http://PREVE-ORG.eu
  • 2. Setting the scene - some statements Healthcare is produced in an organisational setting – and the citizen is “a patient” Healthcare is co-produced in a personal setting – and the citizen is not a patient Healthcare is for acute diseases and conditions – co-production of health is for prevention and chronic diseases A healthy life trajectory is like a journey - navigation is crucial. Heath-navigation is based on shared decisions of which pathways to follow
  • 3. In travel “If you don’t know where you are going, any road will take you there” Lewis Carroll, Alice in Wonderland In personal health You learn were to go and many roads may take you there
  • 4. Conceptual aims Information and patients as resources Nature, Nuture, and collaboration with institutionalized health care Personalized management of prevention and care of chronic diseases – in a citizen context Multilevel ICT-modeling of health and disease encapsulated in to personal devices – Personal Guidance Systems (PGS)
  • 5. The Citizen as Co-producer of Health – enabled by Information and Communication Technology Health Service Delivery Citizen as proactive subject Client Centred Approach Patient Centred Medicine Citizen as co-Producer of Health Disease prevention Disease compensation Model & (Disease cure) Concepts Assisted living Maturity of ICT User as Operator Expert Systems User as User Corporate Centred Contemporary Layman Systems State of the Art Individual Centred in ICT and Ambient Assisted Living Empowerment Citizen as object
  • 6. The PGS Service-model (diabetes as example) General Super- Practice market Specialist- Restaurant centre Car Pharmacy Farm Museum Hospital Home Sports centre Work
  • 7. Data–Information–Knowledge-Decisions Data is a simple value-set without context, than can be stored and exchanged electronically - if there is technical interoperability e.g. 130/95 Information is a simple message where the value-set is provided a predefined context. Information can be exchanged electronically if there is semantic interoperability (e.g. blood pressure measured to the value of 130/95 mmHg) Knowledge is information provided a dynamic personal and organisational context and relations to other knowledge. Knowledge can be utilized and exchanged using computer- models and ontologies (e.g. blood pressure of 130/95 is abnormal in Peter a 25 year old diabetic patient) Decisions are made on the basis of knowledge
  • 8. The Personal Guidance Systems Service- model (diabetes as example) Commodity service providers Information Health providers Knowledge Personal device Data Exercise Diabetic
  • 9. The machine-room of the “Citizen as co-producer of health” (the ECO-system building blocks) Political, social, economic Data Information Knowledge access Co-producers Choice architectures HealthGPS (digital avatar)
  • 10. Apoteket
  • 11. Apoteket
  • 12. Decision support - personal level Fitness centre Home Physiotherapist Hospital
  • 13. Decision support – the societal level Quality Assurance – Governance Information Clinical encounter EHR HMO/ Region HealthPGS Quality (digital avatar) Assurance The citizen controlled and shared information is taken in to Healthcare Hospital the QUALITY ASSURANCE LOOP Co-production
  • 14. Decision support – Research Clinical encounter Research/ Pharmaceutical Co PGS (digital avatar) Patient-NGO Hospital
  • 15. Decision support – Research Clinical encounter EHR HMO/ Research/ Region Pharmaceutical Co Health-PGS Quality (digital avatar) Assurance Healthcare Patient-NGO Co-production Hospital Research
  • 16. The Health-co-production ECO-system Three layer Business Model “App store” - the model library of health conditions Build by community research and innovation; maintained and certified by Patient-NGO’s; NEW business opportunity for especial SMEs The platform(s) for ICT-services Build and maintained by enterprise- vendors. Specified and tested by EC in a (major) CIP-like project The “Communication and Semantics” layer – specified by Standards
  • 17. Decision support – in prevention Contemporary service model (provider push) of prevention: •Non-specific lifestyle modifications •Primary prevention (e.g. immunisations) •Secondary prevention – (e.g. screening programs) •Tertiary prevention of complications to disease
  • 18. Decision support – in prevention From the citizen point of view there is no distinction between primary, secondary and tertiary prevention - it is all evidence- and knowledge-driven behaviour based in personal-context, ICT-augmented decisions
  • 19. Evidence Based Associations between Risk Factors and Conditions Diseases and Disorders Risk Factors Type 2-diabetes Tobacco smoking Preventable cancer Alcohol consumption Cardiovascular disease Diet Osteoporosis Physical activity Musculoskeletal disorders Obesity Hypersensitivity disorders Accidents Mental disorders Working environment Chronic obstructive pulmonary disease Environmental factors
  • 20. Decision support – in prevention - Example Evidence of food having impact in Cardio Vascular Disease Reduction i CVD CVD=Cardiovascular Disease, disease risk (%) Reference CI = Confidence interval (95% CI) Wine 32 ( 23-41) Circulation 2002;105:2836-44 (150 ml/day) Fish 14 (8-19) Am J Cardiol 2004;93:1119-23 (114 gr 4x/week) Dark chocolate 21 (14-27) JAMA 2003;290:1029-30 (100g/day) Fruit and vegetables 21 (14-27) Lancet 2002;359:1969-74 (400 g/day) Garlic 25 (21-27) Arch Intern Med 2001;161:813-24 (2.7 g/day) Almonds 13 (11-14) Circulation 2002;106:1327-32 (68 g/day) Am J Clin Nutr 2003;77:1379-84 Combined effect 76 (63-84) Franco OH et al. BMJ 2004;329:1447-50. A “polymeal” of the above would cost 21.60 Great British Pounds per week (2004) and give an average increase in life expectancy of 6.6 years for men and 4.8 years for women And give men 9.0 years more life without heart disease for women (8.1 years).
  • 21. Co-production of Disease Prevention Connections between Risk Factors and Conditions Citizen Modifiable Risk Factors Tobacco smoking Conditions Type 2-diabetes Alcohol consumption Preventable cancer Diet Cardiovascular disease Physical inactivity Osteoporosis Obesity Non-Modifiable Risk Factors Musculoskeletal disorders Accidents Hypersensitivity disorders Working environment Mental disorders Environmental factors Chronic obstructive pulmonary disease Family history and gender
  • 22. There is still some fences to jump and some conventional weapons to drop before we can realise the “Citizen as co-producer of health and prevention”