PREVE project overview - months 1-6


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

PREVE project overview - months 1-6

  1. 1. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action PREVE Overview Project Months 1-6 Niilo Saranummi VTT Technical Research Centre of Finland This project is partially funded under the 7th Framework Programme by the European Commission
  2. 2. Prevention of diseases WHAT
  3. 3. PREVE – in brief • A 12 month Support Action, under the 4th FP7 ICT Call • Four partners • Objective – Identify ICT research directions for the empowerment of citizens in disease prevention and the preservation of health
  4. 4. What PREVE delivers Impact • White Paper identify ICT research directions for the empowerment of citizens in disease prevention and the preservation of health highlighting the need to approach disease prevention from multiple complementary viewpoints. • Articles offered to peer-reviewed journals and to conferences in order to target different stakeholders in disease prevention
  5. 5. PREVE impact • “PREVE will suggest ICT research directions in primary prevention. – Thus it will open a new avenue of research in the PHS where the so far traditional concept “a physician in the loop” does not always apply and the participation of the healthcare sector may be indirect. – The lead idea of the project is “having the individual as a co- producer of health” and empowering individuals to take responsibility of their health with personalised ICT enabled PHS technologies and services. – In this way the project paves the way towards a health service environment where individuals and health professionals work jointly towards health goals.”
  6. 6. Prevention of diseases WHY
  7. 7. The well-known health system challenges PREVE focus • Health expenditure vs. Healthy value At risk © Juha Teperi, STM – What is produced with €’s Ill Under – Quality & Access concerns treated Difficult to – Expectations & Awareness treat Crisis • And the drivers – Ageing & Care ratio – Life styles – Science, Technology and ”Defense lines” Innovation Burden of disease
  8. 8. Prevention is the best strategy • According to WHO, – 77% of the disease burden in Europe is accounted for by disorders related to lifestyles. Furthermore, 70% of stroke and colon cancer, 80% of coronary heart disease, and 90% of type II diabetes could be prevented by maintaining healthy lifestyles. • The best prevention strategy is to lead a healthy lifestyle. • But, although we are constantly “bombarded” with health promotion information that we should exercise regularly, eat healthy, control our weight, sleep enough, manage stress, not smoke and use alcohol only moderately etc. as a population we are not doing a good job in acting according to this advice.
  9. 9. Clearly, people need assistance • Based on this it should be clear that we as individuals need assistance in primary prevention. • The questions are – What kind of assistance and – How the assistance should be made available / offered and – How to ensure that the assistance provides effective help to the individual in changing and maintaining her lifestyle.
  10. 10. Health behaviours, Personalization, Environment Co- producer ICT in Disease Prevention network Networked business models Prevention of diseases Value proposition, validation HOW PREVENTABLE DISEASES  ICT ENABLED PRIMARY PREVENTION
  11. 11. PREVE workflow – 3 phases Where we are now Barcelona Workshops Milan 16.3.2010 8.11.2010 Belfast 14.6.2010 M9 31.11.2010 1.12.2009 Select the User White paper Business ICT Research diseases & segments & models and Directions in best Personal validation Primary practices profiles Prevention (T3.1 – 3) (T2.1) (T2.2 – 4) (T3.4)
  12. 12. Workflow in more detail Personas Demand (WP2, Completed) Preventable Clinical risk Health Personal Intervention diseases factors behaviours profiling needs Co- Individual + Co-creators producers Environment ”My Health Business Value Business Brokering of Project” cases proposition models best fit Supply (WP3, WIP)
  13. 13. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action WP2 – Analysis of the Domain Vicente Traver Universidad Politécnica de Valencia This project is partially funded under the 7th Framework Programme by the European Commission
  15. 15. WP2 Original specific objectives To analyze in-depth and refine the framework for PREVE project and of the target domain: boundaries, concepts, basic facts and benchmarking of ongoing initiatives in primary prevention and in PHS. To describe the intervention model for primary prevention considering the citizen as a co-producer of health. To assess the different and similar characteristics of the different population groups that could benefit from primary prevention PHS. To specialize the basic intervention model with the different population groups generating a matrix of intervention models for different user segments. To discuss and refine the findings in two expert workshops
  16. 16. Tasks T2.1 Selection of diseases and analysis of best practices in their prevention, incl. lifestyle management & modification (M1-M4) T2.2 Analysis of primary and secondary prevention strategies deployed in ongoing EU funded PHS projects and of the market place (M1-M6) T2.3 Personal profile, motivation, user segmentation (M1-M6) T2.4 User segmented intervention strategies (M1-M7)
  17. 17. WP2 alignment within PREVE Workshops Barcelona Milan 16.3.2010 8.11.2010 WP2 Belfast 14.6.2010 31.11.2010 1.12.2009 Select the User White paper Business ICT Research diseases & segments & models and Directions in best Personal validation Primary practices profiles Prevention (T3.1 – 3) (T2.1) (T2.2 – 4) (T3.4)
  18. 18. WP2 Outputs and milestones 1st PREVE Workshop, March 16th, 2010, and Advisory Panel Meetings in Barcelona, March 15th and 16th. D2.1 Selection of the D2.2 Selection of the relevant diseases and their relevant diseases and their prevention strategies prevention strategies (final (draft) (M3) version) (M4) 1st milestone
  19. 19. WP2 Outputs and milestones 2nd PREVE Workshop, June 14th, 2010, and Advisory Panel Meetings in Belfast, June 13th and 14th. D2.3 User segmented D2.4 User segmented intervention strategies intervention strategies (draft) (M6) (final version) (M7) 2nd milestone
  20. 20. Lessons learnt • The most prevalent preventable non-communicable diseases are all lifestyle related • Relationship disease-disorder  risk factor • Through prevention, scientific evidence of impact on risk factors • Citizen as health co-producer • The citizen has the responsibility to manage her health and wellbeing
  21. 21. Lessons learnt • A 3D framework for health behaviour and behaviour change has been constructed based on a thorough analysis of existing theories, best practices and other ongoing initiatives • Tailoring vs segmentation. Segmentation only valid when resources for intervention implementation are low and the targeted behaviours are relatively simple • Personas description to illustrate the process of profiling and choosing intervention strategies
  22. 22. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.1 - The Citizen as Co-producer of Health & Conceptual Framework for Chronic Disease Niels Boye University of Aarhus, Denmark This project is partially funded under the 7th Framework Programme by the European Commission
  23. 23. The Citizen as Co-producer of Health – enabled by ICT Health Service Delivery Citizen as proactive subject Client Centred Approach Citizen as co-Producer of Patient Centred Medicine Health Disease prevention Disease compensation Model & Concepts (Disease cure) Assisted living Maturity of ICT User as Operator Expert Systems User as User Contemporary Layman Systems Corporate Centred State of the Art Ambient Assisted Living Individual Centred in ICT and Empowerment Citizen as object
  24. 24. The “Present Terrain” “Biological age” (“years”) Demand side 100 AAL Supply side 0 100 % (100% Patient Citizen) Tele Prevention med 0
  25. 25. The Future......... “Biological age” (“years”) 100 Chronic Preven- AAL Tele- Disease tion medicine Management and D D Lifestyle (100% Patient Citizen) D D 100 % 0 0 Society Hospital
  26. 26. Conceptual Aims of “the Citizen as Co-producer of Health Model" • Information and patients as resources • Nature, Nurture, 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 Services (PGS) From: “Background document for the Consultation meeting on potential European Large scale Action (ELSA) on eHealth” European Commission “ICT for Health Unit, H1, 28.08.2009
  27. 27. The Personal Guidance System • Is a ICT device: based on computer-models of healthy- and preventive-behaviour, achievable evidence-based pathways of cure, compensation, or treatment for disease related conditions • The Personal Guidance System contains computer-models for navigation in health similar to the GPS that contains a model of geography and possibilities in travel • The PGS provides the personal context of health related decisions and is the ICT-platform for the “Citizen as Co- producer of Health”.
  28. 28. Decision support information flows Data - and Clinical Information encounter flow EHR HMO/ Research/ Region Pharmaceutical Co Health-PGS Quality (digital avatar) Assurance Healthcare Co-production Research Hospital Patient-NGO
  29. 29. Decision Support Present service model • 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
  30. 30. Prevention in the Co-Producer Model context • From the citizen and co-production of health point of view there is no distinction between primary, secondary and tertiary prevention • It is behaviour planning and execution on the basis of personal-context, evidence-, and knowledge-driven ICT- augmented decisions
  31. 31. 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
  32. 32. Co-production of Disease Prevention Connections between Risk Factors and Conditions Citizen Modifiable Risk Factors Tobacco smoking Conditions Citizen Modifiable Risk Factors 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
  33. 33. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.2 – Analysis of primary and secondary prevention strategies deployed in ongoing EU funded PHS projects and of the market place Teresa Meneu UPVLC Universidad Politécnica de Valencia This project is partially funded under the 7th Framework Programme by the European Commission
  34. 34. Objectives Revision of research projects of ICT and primary prevention Revision of commercial products, websites and online health promotion organizations Revision of complementary domains: secondary and tertiary prevention, marketing Revision of public health campaigns
  35. 35. Main Figures Focus of the prevention projects 40% 35% 30% 25% 20% 15% 10% 5% 0%
  36. 36. Main Figures Focus of the prevention websites 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0%
  37. 37. Main Figures Type of products 18 16 14 4 12 10 Other products 8 1 Videogames 6 12 4 3 7 2 6 2 3 3 2 2 2 0
  38. 38. Main Figures Most Common Risk Factors 50% 45% 40% 35% 30% 25% Projects 20% Websites / 15% Organizations 10% 5% 0% Diet Physical Obesity Others inactivity
  39. 39. Public Health Campaigns Dietary Habits, Tobacco Alcohol Physical Melanoma Vaccination Drugs Activity & Obesity
  40. 40. On PREVE website it has been created a database to collect all related works: websites, products and projects, focused on prevention of diseases and risk factors.
  41. 41.
  42. 42. Conclusions Isolation of initiatives • Little signs of interoperability either on a technical or at a conceptual level. • The original purpose of the projects is mainly focused in a specific domain and was not expecting to be used or profited in conjunction with others. The number of secondary prevention experiences is much bigger that those of primary prevention • More mature market • More well defined conditions • More funding allocated to this domain • They could provide some useful information related mainly to motivation • Not applicable to the same extent to business models or technological solutions. General lack of sustainable trustable business models linked to primary prevention • Most successful initiatives are very simple and sold as ’consumer’ products, for leisure, pleasure or beauty . • Interesting models linked to some healthcare initiatives: Kaiser, Mayo Clinic, Healthvault, Google Health, Reduced participation of multiple actors in the co-creator model, most solutions have only the individual and, in some cases, the healthcare system.
  43. 43. Conclusions Reduced presence of external influences (society, family, etc) in the picture besides the initiatives linked to web 2.0. Interesting results in peer motivation and support in similar domains that could be applied to primary prevention. The most apparently successful results are based in the physical activity domain. General awareness of main risk factors and potential diseases, aligned with the results of D2.2. Reduced support to practical implementation of strategies but much more provision of semi-personalized guidelines. Most projects just do population based personalization (segmentation) and some tailoring based in a few set of individual parameters (i.e. BMI).
  44. 44. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.3 – Personal profile, motivation, user segmentation Kirsikka Kaipainen VTT Technical Research Centre of Finland This project is partially funded under the 7th Framework Programme by the European Commission
  45. 45. Objectives • To analyze different motivation strategies proposed in literature and implemented in current activities that are or could be applied to lifestyle management and modification, especially drawing from the experience in advertising and marketing • To assess the cultural and socio-economic issues that could affect the effectiveness of the identified motivation strategies • To analyse user segmentation based on life stages • To develop the concept of personal profile based on life stages, risk factors, motivation and socioeconomic factors • A segmentation analysis over the population groups highlighted in task 2.1 for the different diseases, based in the different dimensions that could influence the intervention model • To match the identified motivation strategies with the user segmentation produced in T2.3
  47. 47. Determinants of health behaviour • Various theories and frameworks were investigated – Psychological theories about individual behaviour and stages of behaviour change – Theories of values and motivation – Developmental theories – Communication theories – Social marketing theories – Behavioural economics – Cognitive-behavioural therapies and persuasive technologies  The theories overlap and complement each other – There is no one theory that completely explains behaviour and behaviour change – A hybrid model to include essential factors and their relationships is needed
  48. 48. Determinants of health behaviour Values, Social influences Ability personality, life stages Reasoned Awareness Self-efficacy Intention Public policy behaviour Community Outcome Barriers expectations Organizational Automatic behaviours Interpersonal Environmental contexts Individual
  50. 50. Constituents of personal profile Dimensions for user segmentation Dynamicity
  52. 52. Principles of interventions • Primary aims: – Create or strengthen intention through other determinants – Increase abilities and remove barriers • Guiding principles: – Provide immediate, tangible, personally valuable benefits for healthy behaviours – Frame health-promoting messages in an appealing manner – Guide people with appropriate choice architectures – Take advantage of trigger events – Make changes on multiple levels by involving different actors – Identify co-creators of health and involve them in interventions
  53. 53. PROFILE Monitor trigger Risk factors events and profile Values & motivators updates Resources Channels Assess current Health behaviour Current behaviours Diet Physical Activity Alcohol consumption OK, no Support Smoking current risks behaviour/ Stress maintenance Sleep Mental well-being Risky/poor, Choosing need for behaviour change Identify determinants to appropriate target Intention per Lack of resources Strengthen interventions Evaluate progress, Strong (external, actual behaviour? resources outcomes and profile abilities)? updates Weak or nonexistent Not aware of risks Discouraging social Unfavourable outcome and benefits / Weak self-efficacy? environment? expectations? misconceptions? Strengthen social Improve self- Improve outcome Educate independence / efficacy and skills expectations increase support Execute the Select methods & tailor intervention the intervention Personal characteristics Problem Values & motivators characteristics Personal resources Co-creators Social environment Service environment Physical environment
  54. 54. Personalization of interventions • Targeting vs. tailoring – Targeting: designing interventions for subgroups with common characteristics – Tailoring: fitting an intervention to meet the personal needs and characteristics of a person rather than a group • The most effective approach, but traditionally costly • ICT could enable deeply personalized, cost-efficient interventions – A Do-It-Yourself (DIY) platform for profiling yourself and to select interventions that match your profile – Means for data entry, assessment, monitoring, context- awareness, feedback  personal guidance and motivation
  55. 55. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.4 – User Segmented Intervention Strategies Teresa Meneu UPVLC Universidad Politécnica de Valencia This project is partially funded under the 7th Framework Programme by the European Commission
  56. 56. Main Objectives To put together the collected information from the previous tasks by: • Defining the primary prevention intervention model and differentiating its main dimensions. • Describing the disease – best intervention strategies matrix of T2.1 with personalization data resulting in a user segmented disease – best intervention strategies matrix. • Concluding the work in WP2 in valuable outcomes for the next phase of research.
  57. 57. Main Inputs T2.4 Intervention Logic and Profile Draft Primary Prevention Intervention Model & PERSONA’s WP3
  58. 58. Primary Prevention Intervention Model DIY Profiler Broker Analyze Plan Trigger event Evaluate Execute PGS PHS
  59. 59. Personalized Primary Prevention Intervention Model DIY Which is the risk Profiler of the individual? Broker How to select/choose the intervention Analyze Plan strategy? Trigger event Evaluate Execute PGS How to assess the PHS How to put it in practice in evolution and provide the concrete readjustments? time/location/need?
  60. 60. Personalized Intervention Strategies Profiling Matrix Health behaviors Segments that would (and intention) benefit from behavior maintenance interventions No risk Segments in need of lifestyle change with Low risk different levels of urgency Examples of possibly unrealistic segments high High risk Resources low Motivators Life Stages
  61. 61. Profiling Matrix Dimensions Health behaviour is any activity undertaken by an individual which influences health outcomes. • Regardless of actual or perceived health status, the intention can be promoting, protecting or maintaining health, but the attitudes and behaviours can also be harmful, unsafe and damaging to health. Motivation must be present for a lifestyle change to happen and it has much to do about sustainability of the change. • The motivation refers to the reason or reasons for engaging in a particular behaviour and it may be intrinsic, extrinsic or both. The Resources are the tools present in the environment surrounding the individual at his disposal to carry out an interactive action. • There are internal and external resources and they can have a positive or negative influence in the intervention.
  62. 62. The 4th Dimension: Life Stages • Life Stages
  63. 63. From Profiling to Personalized Intervention Tailoring Profiling Personalized Intervention
  64. 64. Monitor trigger PROFILE events and profile Risk factors updates Values & motivators Resources Assess current Health behavior Channels Diet Current behaviors Physical Activity Alcohol consumption OK, no Support behavior/ current risks maintenance Smoking Stress Sleep Mental Wellbeing Student, motivated, healthy habits: She is a female. Risky/poor, need for behavior change She is 20 years old and a student. She lives in a city Identify determinants to 1. Student Strengthen and with her boyfriend. Her main values are: Yes target resources achievement, security, power and self-direction. Evaluate progress, outcomes and profile Intention per behavior? Strong Lack of resources (external or actual abilities)? 3. Middle age updates overdoing 2. Corporate Weak or nonexistent wellness Strengthen social Intervention Discouraging social Yes independence / environment? increase support Logic Aware of risks 5. Young old and benefits? person Improve self- Weak self-efficacy? Yes efficacy and skills Not aware / Male Adult, unmotivated, using services of Misconceptions 7. Obese child 4. Housewife community wellness: He is a male. He is 34 years Unfavourable outcome expectations? Yes Improve outcome expectations old and employed. He lives in a city with his wife. 6. Community wellness His main values are: security, tradition and Educate Execute the intervention benevolence. Select methods & tailor the intervention Personal characteristics Values & motivators Problem Personal resources characteristics Co-creators Social environment Service environment Physical environment
  65. 65. Conclusions COMPLEXITY OF THE DOMAIN • Specially in relation to the human nature and its natural reluctance to change a preferred, well established health behaviour, and the incredible high amount of factors and dimensions that need and must be considered to design an effective primary prevention intervention model. • This scenario poses a set of challenges where ICT technologies could definitively play a significant role: • acquiring the required information • tracing the evolution and changes of the person, its context and her risk profile • processing the enormous set of information to create practical decision support tools for the individuals.
  66. 66. Conclusions FULL PERSONALIZATION • Designing effective and sustainable primary prevention strategies is a very personal issue, even for similar risk profiles, the optimal way to manage to reduce or overcome said risk presents different faces depending on the concrete individual. • Different moments of life, different situations or events, present or past, would imply an instant need to recalibrate the intervention strategy as the things that were effective in the past may no longer be applicable. • The large number of relevant health determinants shows that interventions need to be tailored in order to meet the personal needs and characteristics of a person. In segmentation compromises would have to be made that would limit the potential success of the interventions.
  67. 67. Conclusions ICT ENABLING MULTILEVEL STRATEGIES • The number of theories is large but yet no one has proven to be the most suitable for all individuals and all situations. • Different scenarios may need a different approach or even a combination of those. • The inclusion of ICT technologies into the picture and the way it would affect the behaviours has not been extensively studied or validated and could cause differences in the efficacy on the different theories. • The use of ICT to support the interventions could dramatically change the limitations and boundaries that current intervention models have in relation to the selection or one or another strategy for behaviour change.
  68. 68. Conclusions PREVENTION ECOSYSTEM • Inclusion of third parties in the intervention cycle: co- creators • Some of the co-creators will truly interact with the individual in co-creating health. Others will participate through the choice architectures and defaults that they set through policies and other actions. • The influence of the environment is very strong and is dynamically present in the prevention model. • Co-creators need to be accommodated into the intervention strategies.
  69. 69. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Outlook Months 7 – 12 Niilo Saranummi VTT Technical Research Centre of Finland This project is partially funded under the 7th Framework Programme by the European Commission
  70. 70. Completion of 3rd phase Workshops Barcelona Milan 16.3.2010 8.11.2010 Belfast 14.6.2010 31.11.2010 1.12.2009 Select the User White paper Business ICT Research diseases & segments & models and Directions in best Personal validation Primary practices profiles Prevention (T3.1 – 3) (T2.1) (T2.2 – 4) (T3.4)
  71. 71. Prevention of diseases CURRENT STATUS (CONTINUED)
  72. 72. The health co-production ECO-system Political, social, economic environment Co- Policies producers Incentives Barriers HealthGPS (digital avatar) Platform services (security, ID) PHR
  73. 73. The health-co-production ECO-system Three layer ICT Business Model • “App store” - Library of applications for managing health behaviours. – Built by community research and innovation – Maintained and certified by Patient-NGO’s – NEW business opportunity for SMEs • Platform(s) for ICT-services. – Built and maintained by enterprise vendors. – Specified and tested by EC in a (major) CIP-like project • The interoperability and security layer. – Specified by Standards and Directives.
  74. 74. Co-producers / co-creators of health personal trainers, restaurants, food markets, school, workplace, media, healthcare professionals ...
  75. 75. The environment matters ”Preloading” to create favourable conditions Society ”upstream” Communities Organizations Friends Individual & family ”downstream”
  76. 76. Examples of business cases who ”owns” the customer • Worried well & Fitness – Individuals pay out of their own pocket – Third party life insurance companies are interested • Corporate wellness – The company makes H&W services available to employees – Reduction in insurance premiums (sickness, retirement) • Society – policies – School wellness programs • Integrated care providers (e.g. Kaiser Permanente) – If prevention is the best strategy it will be in the interest of IC providers to keep patients out of hospitals • Health-related consumer goods & service industries – Food & beverage – Sports & fitness – Media & edutainment – Consumer electronics
  77. 77. PREVE specific impacts • Facilitating the development of prospective aspects of ICT-enabled prevention of diseases – “White Paper” – ICT research directions • Reduced hospitalisation and improved disease management and treatment at the point of need, through more precise assessment of health status – Proactive health management, i.e. Primary prevention • Economic benefits for health systems without compromising quality of care – Freeing scarce resources to the care of the ill • Reinforced leadership and innovation of the industry in the area of Personal Health Systems and medical devices. New business models for health service providers and insurance sectors – Health behaviours, Personalization, Networked business models, N = 1, … • Improved links and interaction between patients and doctors facilitating more active participation of patients in care processes – Co-creator network, Individual + Environment • Accelerating the establishment of interoperability standards and of secure, seamless communication of health data between all involved partners, including patients – Continua, HL7 contacts
  78. 78. PREVE partners Valtion teknillinen tutkimuskeskus, VTT Aarhus University Fondazione Centro San Raffaele del Monte Tabor Universidad Politécnica de Valencia