ACT Project Methodologies for assessment of coordinated care and telehealth - IFIC 2014 Cristina Bescos, Helen Schonenberg 9/22/2018 ACT Programme

Description “Identify ‘best practice’ organisational and structural processes supporting integration and implementation of telehealth in a care coordination context for routine management of chronic patients” The ACT program is an assessment and evaluation project for Care Coordination & Telehealth Deployment Collect and share best practices between members 9/22/2018 ACT Programme

Maturity Map Phase 1: Planning of change This phase covers landscaping of the situation, knowledge acquisition, business case analysis and planning and preparation activities to the level of definition of technical and functional requirements, service specifications, selection of providers and users, setting the procurement system and staff/user capability planning. Phase 1: Planning of change The second phase includes an initial introduction of changes in a geographical/organisational environment (one or several projects) for a limited duration pursuing a detailed review of the intervention and impact before decision to large scale long-term commitment. This phase includes refinements of the outcomes of the planning phase based on the experience accumulated. The new models/services could still be stopped without major impact to the rest of the social and HC organization. Phase 2: Adaptation phase Point of non-return reached. This phase covers a full deployment of new services under a sustainable infrastructure and organization. Services are adequately monitored and evaluated. The services are running, performing with certain stability. Phase 3: Full scale implementation phase The performance of the healthcare system is reviewed and some further changes are introduced to improve efficiency and efficacy or enlarge the scope/coverage of integrated care. Refinements of services and new solutions are incorporated in a non-disruptive manner. Phase 4: Continuous improvement after deployment

Phasing Maturity map (Outcome Barcelona & Brussels workshop) Projects Healthcare services Healthcare & social services Phasing Maturity map (Outcome Barcelona & Brussels workshop) Northern Netherlands Catalonia Basque Country Lombardy Scotland Continuous improvement after deployment Full scale implementation phase Planning of change Early adoption BC NN Lo Sc Ca Sc Organisational model Workforce development Development of population stratification tools Integrated care pathways User involvement/Patient engagement Support of technology for the new care model Lo Lo Sc Lo Sc Lo Sc Lo Sc Sc Lo

Methodology Based on literature, clinical & regional experts, Definition, collection, monitoring & analysis of Key Performance Indicators that measure CC&TH deployment success Drivers indicators that influence Key Performance Indicators ACT Evaluation engine Systematic automated way to collect, store and aggregate data Provides interactive access for regions and clinical experts Analysis results Benchmarking within or across regions 9/22/2018 ACT Programme

Evaluation Frameworks INAHTA EUnetHTA MAST NTOIP Description International network of agencies for health technology assessment Consortium of 57 non-profit organizations European network for health technology assessment (HTA) Includes 64 HTA Organizations Model for assessment of Telemedicine applications MethoTelemed study National Telehealth outcome indicators project Application Whether or not to fund a Telemedicine application Should we replace an existing healthcare application by Telemedicine? Assessment of medical and surgical interventions ad diagnostic technologies Decide whether or not to use new Telemedicine applications Choose the most appropriate technology to be used Identification and definition of a small number of simple and meaningful outcomes for consistent application in Telehealth evaluation Goal Assess Telehealth technology Explore deployment of Telemedicine Development of a framework for the assessment of Telemedicine applications Develop/ promote good practice in HTA methods and processes Facilitate local adaptation of HTA information Help reduce unnecessary duplication of HTA activities Publish book with guidelines Provide framework for assessing Telemedicine applications Model for new studies Checklist for inclusion of domains and outcomes in new studies Model for assessment based on literature reviews Move focus from easy input measures and process outcomes to more complex challenges Clarify hierarchical relationships between outcome indicator elements ACT Application Evaluate care coordination and Telehealth deployment Goal Identify CC&TH best practices Publish best practices Facilitate deployment of best practices 9/22/2018 ACT Programme

Evaluation Frameworks INAHTA EUnetHTA MAST NTOIP Framework General considerations: technical assessment, effectiveness, study design, quality of life measures, other outcomes Costs: direct, indirect, intangible Economic evaluation Sensitivity evaluation 9 domains: health problem, description of technical characteristics, safety, effectiveness, cost and economic evaluation, ethical, organizational, social and legal. Describes purpose, relevant alternatives, scope of assessment and application maturity 7 domains: health problem & characteristics of the application, safety, clinical effectiveness, patient perspectives, economic, organizational, socio cultural, ethical and legal aspects Describes transferability of results 5 domains, outcome Category: health status, non-medical determinants, health system performance, community and health system characteristics Theme: quality, accessibility, acceptability, cost Indicator: the variable to assess Measure: the visible effect of a TH related intervention Tool: instruments to collect data for any single outcome measure Notes Suitable for development, initial assessment and long term assessment Only suitable for mature applications. Outcomes focused, processes are not included ACT Framework Per CC&TH area: (1) stratification, (2) care coordination & workflow management, (3) patient adherence & staff engagement, (4) efficiency & efficacy outcomes Domains based on INATHA, EUnetHTA, MAST, NTOIP and expertice from clinical experts and regions Notes Process and outcomes oriented framework Different maturity levels of CC&TH implementations 9/22/2018 ACT Programme

Evidence Drivers Outcomes Population Stratification Method Diseases Age Deprivation Index Past use of HC resources Patient Stratification Health status Frailty Capabilities Care Coordination and WF management Coordination of care Org. structure & function Technology Care Pathways Patient Adherence Introduction Belief Experience with TH technology Staff Engagement Leadership Awareness Motivation Workforce development Creating psychological ownership Organizational change Efficiency & Efficacy Case ascertainment Health outcomes Clinical management goals Process outcomes Service utilization Economic outcomes Patient Adherence Adherence Satisfaction Acceptance Benefits 9/22/2018 ACT Programme

Challenges CC&TH implementation is not led by us, Variations: implementation, maturity level, evaluation goals Lack of data collection standards / methods Variations in interpretation reported values, Variations in reporting level (regional, program, org. unit) Access to population-level data only Limits analysis possibilities Due to: lack of direct access, trust, or high effort Attitude is changing Acceptance of results in clinical domain (no RCT) 9/22/2018 ACT Programme