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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - LIVE INCITE (Lifestyle intervention in the perioperative process through digital service)

Teaser

Summary

It is well known that health care outcomes in the perioperative care process correlate with severity of disease, operational procedure and co-morbidity as well as reduced effects of rehabilitation. Only recently, it has been proved that also the lifestyle factors of the patient are independent risk factors for a poor outcome after surgery and that significant reductions in post-surgery complications and rehabilitation can be achieved by introducing individually targeted intensive lifestyle interventions programs; research showing a reduction of the risk for complications from >40% to <20% with a 6-8 week smoking cessation program. Similar effects are achieved with hazardous alcohol drinking, where a 4-week program reduces the number of complications with 50% after colorectal resection. Thus, methods to alter dysfunctional behaviors such as smoking will have a significant impact on patientsâ€™ health as well as societal costs related to health care.

Relating to the core use case of LIVE INCITE, overall 26% of Europeans smoked in 2014 and the European average alcohol intake (among persons above 15 years of age) is the highest world-wide, including up to 10-15% risky drinkers. In Europe there are some 14 million elective surgeries performed each year.

The core goal of LIVE INCITE is to facilitate the development of digital solutions to empower patients to change risk behaviors prior to and after surgery. The solution should allow for individualized analyses and interventions based on evidence based methods for behavior change and leverage the potential of technology to maximize the reach of the interventions compared to current face to face intensive intervention programs.

The core case in LIVE INCITE constitutes complete quitting of smoking and risky alcohol drinking in relation to knee and hip surgery. However, it is essential for success and long-term sustainability and value that the solution is sufficiently flexible to allow for other and co-existing risk factors, medical conditions and care contexts, allowing for scaling beyond the core case.

The overall objectives of the project is to drive the creation of a market of flexible, sustainable digital solutions to enable care providers to, increasingly effectively, continuously improve care by addressing the complex task of behavior change in relation to harmful life style risk factors.

Work performed

The LIVE INCITE preparation phase started in November 2016 and ended in September 2017.

The objective of the preparation phase has been to engage the market, prepare the internal organizations within the consortium and detail the scope and document the details of the PCP.

Open market consultation:
During the preparation period, the project has engaged in a dialogue with the market to learn more about the state of the art solutions currently available and the possibilities for LIVE INCITE related to new technology and user experience concepts in general. The project published a market survey document to communicate the problem and overall concept of LIVE INCITE, performed two open information meetings (Stockholm and Barcelona), and engaged in one on one meetings with any interested stakeholder to gain further market input. Besides several important insights from the market on the challenge, one important general outcome of the open market consultation activity performed was that the LIVE INCITE project was promoted to and caught the interest of a wide market, establish an interest in and basis for healthy competition for the upcoming PCP tender.

End-user insight:
During the preparation phase, the project gained insights from interacting with end-users to learn more about their needs. A survey was performed with some 1600 previous patients and workshops with some 40 patients as well as performed several workshops with clinicians.

Knowledge synthesis:
During the preparation phase, the project has also performed (as part of work package 7) a knowledge synthesis activity during which the most current research in the field of post-surgery complications related to life style risk factors and intensive intervention programs was collected and summarized. This for ex. lead to the insight that complete quitting of smoking had been proven by latest research to have the desired effect only four (4) weeks in advance to surgery, compared to the previous evidence of 6-8 weeks. This insight positively strengthened the plans for the pilot during phase 3.

Defining and describing sustainable success:
Further, extensive work has been performed by the team in leveraging the knowledge of our behavior scientists to secure that the whole team has insights into the theories behind behavior change and that such was summarized to the market in the request for tender. The team has also worked extensively with securing that the challenge, and related award criteria evaluation framework, stressed the long-term flexibility and sustainability required for success. One example is stressing the use of continuous analysis of outcomes and being able to turn such insights into improved intervention program content/timing etc. and to stress the need for a solution to be open and interoperable to cope with different care provider environments and data integration pre-requisites.

Overall, the preparation phase has been conducted with a focus on gaining more detailed understanding about how to best define the challenge and the project is ready to enter the tender process for the PCP.

Final results

The project expects to drive the development of solutions moving well beyond content-focused, single-risk factor, limited use of evidence based behavior change theory, and mostly void of modern data computing technologies which today exist for personal health apps and smoking cessation. The context of the perioperative process differs from that of personal Health. A solution needs to address the task of achieving the desired behavior change with an evidence base and reliability creating legitimacy and effect meeting the standards of healthcare. As of today, only face to face programs is used for intensive intervention programs but such are expensive and non-realistic to scale widely. Harnessing the latent potential of modern technology, using the best available knowledge of the pre-requisites for individualized and contextualized behavior change, and leveraging state of the art user experiences in a digital solution which support many patients to be supported to achieve the desired behavior change. This will mean a progress well beyond current face to face programs or what is used in commercial, fitness or similar single-purpose apps. Further, the non-disputable need to be able to learn and adapt, realizing the complexity of the issue and that success will be found by iterations and continuous improvements, is likely to bring state of the art machine learning/AI technology into the mix.

The project expects to fuse modern technology with the insights of intensive intervention programs and behavior change professional knowledge and drive the emergence of a market in which data driven approaches enables individualized, contextually aware digital support. The expected gain is to enable many patients planned for surgery to change their behavior prior to the surgery and thus lessen the rate of mortalities and complications among the approximately 25 % of Europeâ€™s 14 million surgeries yearly, with a great impact societal and economic impact.