(by Giancarlo De Leo Consultant in Medical-Scientific Publishing and Digital Health, Partner and Secretary of the AIDR Digital Health Observatory)
Integrated Home Care (ADI) is a care formula dedicated to the elderly and to all people who are not self-sufficient. An assistance that takes place at the sick person who needs it, whether it is an elderly person or a person suffering from an invasive disease.
It is a formula that has two fundamental cornerstones at its base: humanization of care and proximity to the patient.
A solution that lightens the burden faced by hospitals, because it treats and assists the sick at their home.
Those who choose to make use of ADI services generally face problems that need to be managed on a daily basis. These are medical treatments, but also nursing support and rehabilitation therapies.
Among the possibilities of help there are also extremely important social assistance services.
The ADI is carried out at home and has no cost for the applicant because the costs are borne by the National Health Service.
It is a support that, based on actual needs, can cover a few days of the week, or work 7 days a week and which concerns both the nursing, social and physiotherapy plan, together with some specialist visits.
As regards the application, the procedure may vary depending on the region of residence and the competent local health authority. The request should start with the primary care physician, but can also be made by a hospital specialist, social workers or a health district.
The application is examined by the Multidimensional Evaluation Unit (UVM), which draws up the Individualized Assistance Plan (PAI), with the program (which specifies the necessary specialist figures and the therapeutic methods to be implemented towards the beneficiary) and the therapy suitable for the patient.
A best practice of Integrated Home Care Management Experimentation: The ADIGest project of the ASL of Brindisi
The ADIGest project stems from the will of the Brindisi ASL to carry out an Integrated Home Assistance Management experimentation by setting up a Public Private Partnership between the ASL and a private entity. The intent is to improve the service at the same cost and benefit from all the advantages deriving from a concrete reorganization of the ADI service in the entire province of Brindisi in an efficient and effective way: efficient through a rational reallocation of costs and charges, effective because it aims to a high supply and a high standard of perceived quality of service in the population.
Almost two years after the eHealth article, how important is digital in the Integrated home care service?, Also in light of the current pandemic emergency, we intend to deepen the details of the project's developments and its future prospects in terms of replicability.
All the work of the Integrated Home Assistance of the Brindisi ASL is guided by an IT platform tailored to the service: ADIGest, created by the company THCS srl, and used since 1 December 2016. To date, an objective has been pursued main: digitize the home care delivery process in all its facets with the ambitious aim of optimizing management and operational efficiency and effectiveness. All while maintaining the requirement to make the experience easily replicable in other situations, as required by the Management Experimentation Project, approved by the Puglia Region and the Brindisi ASL.
In line with the Experimentation Project, which provides for the Systematic Review of Processes, a considerable update of the system has been launched, conceived thanks to the experience gained in the first years of service and which provides for an optimization made possible by current technological developments. The goal was therefore to improve the productivity of services, modifying them and integrating them with additional features, some of which have become indispensable in light of the CoViD-19 emergency, such as:
1. The improvement of the System Taking charge and Production Capacity RTI ADI.
During the first years of operation, the need emerged to increase home services until, in certain periods, doubling the number of accesses requested compared to those foreseen in the tender phase. A system has therefore been implemented that optimizes monitoring:
- of the scheduled activity for the reference period (annual, semiannual, quarterly, quarterly or monthly);
- of the commitment, or what corresponds to the activities envisaged by the Individual Plans already acquired;
- the potential for future disbursement, based on the contracted staff.
2. The CoViD-19 monitoring system
Home care workers in the provision of the ADI service have an evident high risk of contagion (and transmission) from CoViD-19, as each enters about ten different homes every day.
A module has been implemented in the platform, which allows the continuous monitoring of the Patient's condition through an update of the Coronavirus Risk Assessment Form. It has been made available to the Integrated Home Assistance Service of the Brindisi ASL (Provider, Healthcare Districts, PUA - Single Access Doors), to facilitate the process of virtual "connection" of people in assistance with the health system, both ADI and people in home isolation. The module simplifies and completely digitizes the production process of the Card, making it compliant with the requirements of privacy guarantee and ensuring that traces are kept over time of the surveys carried out.
3. Smart working of administrative staff, teleconference and remote training
The pandemic emergency made it necessary and desirable to adopt the smartworking tool for administrative staff and to introduce remote connection methods into the system for meetings between Operators, between ASL and private Partner, between Operators and Doctors, etc. … And for training activities. These functions have been implemented that can be used remotely and with proper monitoring of the activities carried out, thus helping to keep the experimentation alive and, at the same time, avoiding close contact.
Today the ADIGest system aims to offer a complete digitalization service to all stakeholders of the Home Care service, not least the citizen, to whom it intends to offer a better service, greater awareness of the care process addressed to him and greater responsibility towards their health, also thanks to the use of a Virtual Assistant - Avatar with which to converse in natural language. All in a smart and effective process and in compliance with the standards set out in the Regional Guidelines for Home Care that would allow him to consult:
- State of the art of practices and requests;
- Schedule of exams or services booked or provided with the operators involved and their references;
- Hospital discharges, physiatric plans, results of reports;
- Indices and data in general, also customizable by level of care or pathology.
Having digitized the entire service has made it possible to achieve several fundamental objectives:
- The increase in the number of clients in care went from about 1.600 to 2.500 after the first six months of activity, it would be unthinkable to manage these numbers on paper and pen and recently dropped slightly only due to the pandemic in progress;
- The ability to monitor in real time the activities carried out by healthcare professionals at home;
- The opportunity, for patients / caregivers and GPs, to consult the Integrated Home Card, in which vital parameters and other telemedicine monitoring data can also be entered;
- The reduction of errors previously caused by the operations carried out manually. This can be found, for example, in transmission errors to the regional system which, if previously amounted to about 10%, today have an almost zero margin of error (in the month of January 2021 only 9 errors were recorded out of more of 26.000 hits sent, less than 0,4 0/00.
The innovation made was first of all organizational and process, then technological for the pursuit of the objectives of Digitalization in Healthcare and following a User Driven model.
The quality of the system is often reported in newspaper articles, in addition the ADIGest System, presented at the contest launched by FPA and Allea with the unconditional support of Teva Italia during the 2017 Health Innovation Forum, received two awards: the InnovaS @ lute2017 "Innovator 2017" and the TEVA Special Recognition in the "Communication and collaboration infrastructure between structures, professionals and administrations" and today is one of the 10 national finalists of the eHealth4all award.
In the guidelines for the preparation of the projects that will make up the PNRR, an important chapter of this document is dedicated to the reform of the Public Administration, we read that "Modernizing the country means, first of all, having an efficient, digitized, well-organized and unburocratized, truly at the service of the citizen. " Well, the ADIGest experience is now consolidated for more than four years of operation and constantly updated in technological terms and is transferable to any reality that provides Home Care services, both public and private, which can replicate the organizational, management and technological model. adopted in the service rendered in the province of Brindisi.