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7. PROGRAM RAMOWY



STRONA GŁÓWNA
Poszukiwanie partnerów do projektów w 7PR

Poszukiwanie partnerów

KPK/2007/2124
2013-04-04
2013-05-14
HOSPICOM: FROM HOSPITAL TO COMMUNITY: A 
PROPOSAL OF INTEGRATED SERVICES OF CARE 
MODEL
ICT

CIP-ICT PSP-2013-7  
Settimo Hospital
Italy
http://www.ideal-ist.eu/ps-it-87990

direttore.sanitario@ospedalesettimo.it
Phone:
+39 011 3021400
Fax:
+39 011 3021421
Chronic conditions represent today one of the most relevant 
problems and challenges in Europe. Reported by the World 
Health Organisation , today, about 80%-90% of deaths are 
due to chronic diseases. But what is particularly relevant , is 
the increasing incidence and prevalence among population 
of the patient with multiple chronic conditions. In all EU 
Member States chronic diseases creates new challenges in 
terms of healthcare organisation, balance between the 
different levels of care and system financing, in a context of 
growing expectations of the population and possible 
decrease in resources available.
 
PROJECT DESCRIPTION
Proposal Outline: 

Chronic conditions represent today one of the most relevant 
problems and challenges in Europe. Reported by the World 
Health Organisation , today, about 80%-90% of deaths are 
due to chronic diseases. But what is particularly relevant , is 
the increasing incidence and prevalence among population 
of the patient with multiple chronic conditions. In all EU 
Member States chronic diseases creates new challenges in 
terms of healthcare organisation, balance between the 
different levels of care and system financing, in a context of 
growing expectations of the population and possible 
decrease in resources available. Furthermore European 
healthcare solutions are preparing itself to the demographic 
change of the next decade. Remote monitoring of patients 
at home is already a common approach, however, current 
solutions shall overcome system management and 
interoperability issues. The issue of chronic diseases requires 
new paradigms of healthcare supply and changes within the 
system in terms of clinical, economical and managerial 
perspective. In particular the lack of integration and 
coordination within the system if considered as one of the 
main weaknesses in most countries. This lack of integration 
concerns the different levels of the healthcare system: 
general practitioners, nurses, specialists, primary care 
institutions and hospitals, as well as community care. 
Another issue regards actions towards the population and 
patients to force cultural change with actions of prevention, 
awareness and direct information. The most important 
transversal issue, however, lies in the financial constraints, 
which have negative effect both on the people’s ability to 
access the system, and on the quality of care received. The 
main Project objectives are the following: Identification and 
validation of models and interventions to support informal 
caregiver  needs such as managing their responsibility and 
other negative outcomes, and to maximise a healthy 
outlook .Proposing general model interactive services (audio 
and video data interchange) running on IoT (Internet of 
Things) for simple, valid, convenient and inexpensive 
interactions among all players. Improvement of 
independent and assisted living >Reliable monitoring and 
more effective services (alerting, training, information 
sharing etc) >Development of the procedures to improve the 
connections both the patients, caregivers, social workers and 
healthcare professional workers (call center, control rooms, 
etc) according to the community and care continuity 
framework. Improvement the quality of life of informal or 
familiar;caregivers who care the patients
 

Keywords: 
 

informal caregivers
 
care continuity
 
community hospital

PARTNER PROFILE SOUGHT
Required skills and Expertise: 

Experts in data entry; experts in statistical analysis; experts 
in project management
 
Description of work to be carried out by the partner(s) sought: 
 
The project pilots are planned to deliver integrated services 
through European e-Health Networks (requirements, pre-
existing infrastructures adaptation, selection of services and 
delivery channels) in the various testing sites thus reaching 
conclusions for the subsequent uptake of the service by 
whole value chain in the corresponding Health and Social 
care market.Pilot set up in cooperation with Settimo 
Hospital At least 20 patients distributed on all the regional 
areas will be monitored for about 12 months. The pilot will 
involves the following stakeholders: Regional government of 
health and innovation Healthcare professional workers: 
specialist, doctors, daily hospital organisations, nurses, 
social assistants, etc Healthcare non professional providers: 
informal care givers, patient associations and volunteers 
associations Target patients: adult and older patients who 
are discharged by the hospital and taken in charge by the 
territorial services at home. The main problems are: The 
administrative information continuity important for the 
family and patients to know whom to refer to in case they 
need information of administrative aspects The case 
management continuity important for the healthcare 
professional workers to know and to keep under control the 
health situation of the patient (e.g.: the clinical exams he is 
going through and the therapy he is following) Expected 
impacts Contribution to improved communications and 
cooperation among healthcare organisations and expert, 
patients , caregivers and Public Administration 
>Contribution to introduction of integrated care solutions 
and processes Enhance quality of life (mainly of patients 
and caregivers) and health outcome benefits >comparability 
between different pilot sites and aggregation of evidence 
>exploitation plan dealing with both the sustainability and 
the scalability of the services beyond the pilot 
phase">Ensure that the business procedures involving the 
new service are updated to support it

Type of partner(s) sought: 

The entire supply chain of the realization of a field test is 
required, for at least other 3 countries, i.e.:
 
·The application player, who can be both academic or 
industrial
 
·Hospitals who can take in charge patients with disability 
and implement the procedure to discharge with territorial 
organisation
 
·Industrial (better if SME) partner involved in commercial 
deployment
 
·Service delivery partners (Public or private organisations) to 
set up multicentric trials
 
·The ICT player, typically a R&D organisations or an 
industrial (better if SME) partner
 
Other possible players to be included in the workflow

Looking for a Coordinator for your proposal: 
No 


CIP-ICT PSP-2013-7 
3.1 Preparing large scale deployment of targeted services to 
support active and healthy ageing 

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