JMIR Publications

ABSTRACT

Background:

Integrated care (IC) can promote health and social care efficiencies through prioritization of preventive patient-centred models, defragmentation of care and collaboration across health tiers, and mHealth can be the cornerstone allowing for such paradigm shift.

Objective:

To assess the patients and health professionals’ acceptability, usability and satisfaction of a mHealth-enabled IC model for complex chronic patients.

Methods:

As part of the CONNECARE Horizon 2020 project a prospective, pragmatic, two-arm, parallel, implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients aged 55+ with chronic conditions, and a history of hospitalizations for chronic obstructive pulmonary disease (COPD) or Heart failure (use case (UC)1); or, a scheduled major elective hip or knee arthroplasty (UC2), were recruited. During 3 months, patients experienced a mHealth-enabled IC model, including a patients’ self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. The Person-centred coordinated care experience questionnaire (P3CEQ) and Nijmegen Continuity Questionnaire (NCQ), assessed person-centeredness and continuity of care. IC arm patients and staff’s acceptability was assessed with the Net promoter score (NPS) and the System usability scale (SUS).

Results:

Analyses included 77 IC patients and 58 controls completing the follow-up, and 30 healthcare professionals. Mean (SD) age was 78 (9) years in both study arms. Perception of patient-centeredness was similarly high in both arms. IC Patients reported better continuity of care than controls (mean (SD) NCQ 3.7 (0.9) vs. 4.0 (1.0); P = 0.038). The scores for patients’ acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean (SD) SUS 79 (14); UC2: mean (SD) SUS 68 (24)) were outstanding. Professionals’ acceptability was low (UC1: NPS -25%; UC2: NPS -35%), while usability was average (UC1: mean (SD) SUS 63 (20); UC2: mean (SD) SUS 62 (19)). Actual use of technology was high: 77% of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight.

Conclusions:

The mHealth-enabled IC model showed outstanding results from the patients’ perspective in two different use cases, but lacked maturity and integration with legacy systems to be fully accepted by professionals. This manuscript provides useful lessons learned through the development and assessment process, and may be of use for organizations willing to develop or implement mHealth-enabled IC for elder citizens.