FP7-ICT-2009.5.1 – Support Action

Directions for ICT Research in Disease Prevention

This project is partially funded under the 7th Framework Programme by the European Commission

The Citizen as Co-producer of Health & Conceptual Framework for Chronic Disease

Management

Niels BoyeUniversity of Aarhus, Denmark

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Client Centred ApproachPatient Centred Medicine

Ambient Assisted Living

Health Service Delivery

Maturity of ICT

Citizen as object

User as OperatorExpert SystemsCorporate Centred

User as UserLayman SystemsIndividual Centred

Citizen as co-Producer of Health

ContemporaryState of the Artin ICT andEmpowerment

Model & Concepts

Citizen as proactive subject

Disease prevention

Disease compensation

(Disease cure)

Assisted living

The Citizen as Co-producer of Health –enabled by ICT

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“Biological age” (“years”)

0

100 %

Patient

0

100

(100%Citizen)

AAL

Telemed

Preven-tion

Demand side

Supply side

The Present

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0

100 %

Patient

0

100

(100% Citizen)

Tele-

medicine

D

D

Chronic

Disease

Management

“Biological age” (“years”)

D

AAL

D

Preven-

tionand

Lifestyle

Society Hospital

The Future

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Personal Guidance Services (PGS)

Conceptual Aims of “the Citizen as Co-producer of Health Model"

• Information and patients as resources• Nature, Nurture, and collaboration with institutionalized

health care• Personalized management of prevention (and care of

chronic diseases) – in a citizen context• Multilevel ICT-modeling of health and disease

encapsulated in to personal devices –

From: “Background document for the Consultation meeting

on potential European Large scale Action (ELSA) on eHealth”

European Commission “ICT for Health Unit, H1, 28.08.2009

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Hospital

Pharmacy

Specialist-

centre

General

Practice

Home

Restaurant

Super-

market

Museum

Sports centre

Farm

Work

Car

The PGS Service Architecture diabetes as example

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Diabetic

Personal

device

Exercise

Health providers

Commodity service providers

Data

Information

Knowledge

The Personal Guidance Systems Service model

diabetes as example

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Data

Information

Knowledge access

The Machine-room of the “Citizen as Co-producer of Health”the ECO-system building blocks

Choice

architectures

Co-

producers

HealthGPS(digital avatar)

Political, social, economic

Platform services (security, ID)

PHR

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Decision support (information flows)

EHR

Quality

Assurance

HMO/

Region

Clinical

encounter

Healthcare

Co-production

Health-PGSPHR and

digital avatar

Research Patient-NGO

Research/

Pharmaceutical Co

Hospital

Data- and

Information

flow

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Decision Support Present service model

• Contemporary service model (provider push) of prevention:

• Non-specific lifestyle modifications• Primary prevention (e.g. immunisations)• Secondary prevention – (e.g. screening programs)• Tertiary prevention of complications to disease

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Prevention in the Co-Producer Model context

• From the citizen and co-production of health point of view there is no distinction between primary, secondary and tertiary prevention

• It is behaviour planning and execution on the basis of personal-context, evidence-, and knowledge-driven ICT-augmented decisions

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Evidence Based Associations between Risk Factors and Conditions

Type 2-diabetes

Preventable cancer

Cardiovascular disease

Osteoporosis

Musculoskeletal disorders

Hypersensitivity disorders

Mental disorders

Chronic obstructive pulmonary disease

Tobacco smoking

Alcohol consumption

Diet

Physical activity

Obesity

Accidents

Working environment

Environmental factors

Diseases and Disorders Risk Factors

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Reduction i CVD

disease risk (%)

(95% CI)

Reference

Wine

(150 ml/day)

32 ( 23-41) Circulation 2002;105:2836-44

Fish

(114 gr 4x/week)

14 (8-19) Am J Cardiol 2004;93:1119-23

Dark chocolate

(100g/day)

21 (14-27) JAMA 2003;290:1029-30

Fruit and vegetables

(400 g/day)

21 (14-27) Lancet 2002;359:1969-74

Garlic

(2.7 g/day)

25 (21-27) Arch Intern Med 2001;161:813-24

Almonds

(68 g/day)

13 (11-14) Circulation 2002;106:1327-32

Am J Clin Nutr 2003;77:1379-84

Combined effect 76 (63-84)

Franco OH et al. BMJ 2004;329:1447-50.

CVD=Cardiovascular Disease,CI = Confidence interval

A “polymeal” of the above would cost 21.60 Great British Pounds per week (2004)and give an average increase in life expectancy of 6.6 years for men and 4.8 years for women And give men 9.0 years more life without heart disease for women (8.1 years).

Decision support – in preventionExample: Evidence of food having impact in Cardio Vascular Disease

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Citizen Modifiable Risk Factors

Co-production of Disease PreventionConnections between Risk Factors and Conditions

Type 2-diabetes

Preventable cancer

Cardiovascular disease

Osteoporosis

Musculoskeletal disorders

Hypersensitivity disorders

Mental disorders

Chronic obstructive pulmonary disease

ConditionsTobacco smoking

Alcohol consumption

Diet

Physical inactivity

Obesity

Accidents

Working environment

Environmental factors

Citizen Modifiable Risk Factors

Non-Modifiable Risk Factors

Family history and gender