Protocol for regional implementation of collaborative self-management services to promote physical activity

Abstract

Background: Chronic diseases are generating a major health and societal burden worldwide. Healthy lifestyles, including physical activity (PA), have proven efficacy in the prevention and treatment of many chronic conditions. But, so far, national PA surveillance systems, as well as strategies for promotion of PA, have shown low impact. We hypothesize that personalized modular PA services, aligned with healthcare, addressing the needs of a broad spectrum of individual profiles may show cost-effectiveness and sustainability.

Methods: The current manuscript describes the protocol for regional implementation of collaborative self-management services to promote PA in Catalonia (7.5 M habitants) during the period 2017-2019. The protocols of three implementation studies encompassing a broad spectrum of individual needs are reported. They have a quasi-experimental design. That is, a non-randomized intervention group is compared to a control group (usual care) using propensity score methods wherein age, gender and population-based health risk assessment are main matching variables. The principal innovations of the PA program are: i) Implementation of well-structured modular interventions promoting PA; ii) Information and communication technologies (ICT) to facilitate patient accessibility, support collaborative management of individual care plans and reduce costs; and iii) Assessment strategies based on the Triple Aim approach during and beyond the program deployment.

Discussion: The manuscript reports a precise roadmap for large scale deployment of community-based ICT-supported integrated care services to promote healthy lifestyles with high potential for comparability and transferability to other sites.

Trial registration: This study protocol has been registered at ClinicalTrials.org ( NCT02976064 ). Registered November 24th, 2016.

Keywords: Cardiopulmonary rehabilitation; Chronic disorders; Integrated care; Physical activity; Service adoption; eHealth.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee for Clinical Research of Hospital Clínic de Barcelona approved the study protocol and the informed consent for the subjects (HCB/2016/0883).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Settings of the implementation studies. The figure shows two interoperable domains with technological elements providing support to the services promoting active lifestyles integrated within the action plan of the patient. On the left, Informal Care area with the patient having access to the Personal Health Folder (PHF) wherein she/he can answer questionnaires, perform monitoring through mHealth apps, and have access to a follow-up reports and tailored educational information, as defined in the work plan (center of the figure). On the right, the Formal Care domain wherein the case manager (physiotherapist) and/or general practitioner has access to an adaptive case management system for work plan prescription, follow-up and coaching. The adaptive case management system supports execution of the patient work plan and provides a bridge of interoperability and collaborative tools among the patient (through the PHF), the case manager and the electronic medical record (EMR)

Fig. 2

Objectives of the implementation studies. The figure displays the four main objectives of the protocol considered as pivotal steps to achieve regional adoption of collaborative self-management services promoting physical activity across health-care tiers. Deployment of three use cases in one of the healthcare sectors of the city of Barcelona will target chronic obstructive pulmonary disease (COPD), cardiovascular disorders (CVD) and type 2 diabetes mellitus (T2DM). A patient-centered approach will be adopted. ICT stands for information and communication technologies

Fig. 3

Timeline for program development. The three implementation studies (Fig. 2) will be conducted in parallel. The 24-month lifespan of the programs will be divided in two main phases of approximately one-year duration each. The initial co-design Plan-Do-Study-Act (PDSA) cycle will be devoted to co-design and refinement of the service workflows, set-up and assessment of ICT-supporting tools, and identification of key performance indicators. During the second PDSA cycle, the program will be adopted at pilot level in the healthcare sector. This second phase will be used to fine tune the services, assess and refine ICT-supporting tools, as well as to consolidate the long-term evaluation plans. The two PDSA cycles will have a multidisciplinary approach including patients and professionals with different profiles (i.e. physiotherapists, nurses, general practitioners, medical specialists and technologists). AIS-BE stands for Integrated Care Area of Barcelona-Esquerra (540.000 citizens)