A Practice-proven, Collaborative, Purely Meta-model-based Adaptive Case Management Approach for Integrated Care

Abstract

A Practice-proven, Collaborative, Purely Meta-model-based Adaptive Case Management Approach for Integrated Care Background: Demographic changes are leading to population ageing in Europe. Elderly patients, aged 65 years or older, are frequently affected by multiple chronic diseases. Simultaneously, insufficiently coordinated treatments can cause undesired side effects. Traditionally, such patients consume a disproportionally high share of health-care resources. Integrated care is widely acknowledged to be a promising approach, but in practise, adequate generic tool support for integrated care is still missing. Such care faces multifaceted challenges with regulatory, organizational and technical aspects, whereas the following high-level challenges are the most critical regarding generic tool support. First, highly context-dependent unpredictable treatments are caused by uncertainties and interruptions typical of knowledge-intensive work. Second, the heterogeneity of available health-care services hinders the required exchange of semantic information. Third, coordination across multiple organizations and different roles is essential. Traditionally, hospital-specific implementations are inadequate, considering the required effort and low reusability. Method: We implemented an Adaptive Case Management approach for Integrated Care (ACM4IC) that follows a purely metamodel-based method and incorporates communication and coordination capabilities. Its primary aim is to provide tailored, hospital-specific and treatment-specific solutions through metamodel-based adaptions rather than custom hard-wired implementations. Our metamodel-based approach enables customisations across three dimensions. First, a purely metamodel-based integration of third-party healthcare services enables easy tailoring of hospital-specific solutions. Second, case templates are modelled as a reusable blueprint for particular treatments. A case template is typically structured into identification, evaluation, workplan and discharge stages. These stages contain task models that represent clinical questioners or integrated-care services. These task models represent integrated care services such as patient blood pressure measurement or a drug prescription added depending on the treatment to a case template stage where required. Third, when treating a patient, a case template is instantiated to guide care professionals while enabling flexible runtime adaptations to tailor the case template according to the patient-centred context. Results: Our ACM4IC is being applied in practice within the European Horizon 2020 integrated care project named Personalized Connected Care for Complex Chronic Patients. Conceptually, this project consists of a Smart Adaptive Case Management (SACM) system for medical professionals and a Self-Management (SMS) system for patient empowerment. The SACM system that orchestrates patient-centric treatment is composed of the ACM4IC with an incorporated decision-support system, whereas the SMS system consists of many micro-services and a mobile application. In the project context, two case studies were conducted in hospitals in Groningen, Tel Aviv and Lleida using the ACM4IC. Case studies and hospital-specific case templates were modelled and continuously adapted since October 2017 while the first patient was admitted in May 2018. Our data represent case studies u