FULL NAME: A Federated Collaborative Care Cure Cloud Architecture for Addressing the Needs of Multi-morbidity and Managing Poly-pharmacy
CALL FOR TENDER FOR PROJECT: Horizon 2020, PHC-25-2015 “Advanced ICT systems and services for integrated care”
PROJECT NO.: 689181
COORDINATION OF THE PROJECT: THE UNIVERSITY OF WARWICK, UK
DESCRIPTION: The goal of the C3-Cloud project is to develop personalised care plans for patients with multiple pathologies, based on evidence and supported by ICT tools and managed by a coordinated multidisciplinary team that promotes integrated care and patient and/or carer involvement.
PROJECT AIMS: The main objectives established in the C3-Cloud project are:
- Development of Personalised Care Plans for multi-morbid patients through systematic reconciliation of evidence-based clinical guidelines.
- Encourage members of the multidisciplinary care team to manage, in a coordinated and collaborative manner, personalized care plans and support them in providing the best possible care.
- Improve communication and coordination between areas and levels of care.
- Encourage the active participation of patients and informal caregivers.
- Facilitate the integration between the different communication systems.
- Identify best practices in the care and attention of patients with multiple pathologies.
- Develop new models and care routes for the provision of integrated care for patients with multiple pathologies.
WORK METHODOLOGY: Divided into 10 work packages – project lasting 48 months
- WP1: Project coordination (Month 1 – Month 48)
- WP2: Dissemination, exploitation and activities related to innovation (Month 1 – Month 48)
- WP3: Design of C3-Cloud system architecture (Month 1 – Month 48)
- WP4: Development of healthcare pathways, organisational models and and change management (Month 1 – Month 48)
- WP5: Patient Empowerment Platform (Month 9 – Month 22)
- WP6: “Middleware” interoperability (Month 9 – Month 18)
- WP7: Coordinated Care and Cure Delivery Platform (Month 5 – Month 26)
- WP8: Development and implementation of C3-Cloud application in pilot sites (Month 1 – Month 45)
- WP9: Impact evaluation and assessment (Month 1 – Month 48)
- WP10: Ethical requirements (Month 1 – Month 48)
- Generation of a new integrated care “C3-Cloud” approach and development of an ICT infrastructure as a solution for integrated care delivery from start to finish.
- Development of “open source” interoperability solutions and decision-making support modules that facilitate integrated care in Europe.
- Application and validation of the C3-Cloud strategy in 3 European regions with differences in the healthcare systems and infrastructures available.
- Development of healthcare pathways for multi-morbid patients and organisational models, based on qualitative and quantitative assessments after pilot intervention.
- Development of an innovative large-scale impact modelling tool for industrial exploitation and scaling-up process.
- ROLE OF KRONIKGUNE IN THE PROJECT: Kronikgune, in addition to being the leader of work package 8 (WP8) “Development and deployment of the C3-Cloud application on pilotsDevelopment of the application and implementation on pilots”, it is actively involved in risk stratification, the development of new integrated care pathways and in the design of pilots and training for end users.
- ROLE OF OSAKIDETZA IN THE PROJECT: Osakidetza is leader of work package 4, “Development and change management of healthcare pathways and organisational models”. In addition to being one of the pilots where the intervention will be implemented, it has key relevant role in the clinical experience in the development of the platforms and is responsible for the reconciliation of the clinical guidelines used in the decision making and piloting the application.
- Coordination: Lola Verdoy; Ane Fullaondo; Esteban de Manuel.
- Core: Antonio de Blas; Nicolas González; Amaia Martínez; Estibaliz Gamboa Moreno; Mikel Ogueta; Rafael Rotaeche; Arritxu Etxeberria; Marian Cidoncha, Garrastatxu Landaluze; Javier Urraca; Ariadna Besga; Amaia Saenz de Ormijana; Dabi Santano; Igor Zabala and new participants pending confirmation.
- Evaluation: Javier Mar
- IHO Donostialdea
- IHO Alto Deba
- IHO Araba
- IHO Bilbao – Basurto
- IHO Ezkerraldea-Enkarterri Cruces
- Sub-directorate of IT and Information Systems
- Integrated Care and Chronicity Service (SIAC)
- Multichannel Health Service between the Patient and the Health Service (Osarean)