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Case Reports
. 2022 Oct 7;22(4):1.
doi: 10.5334/ijic.6503. eCollection 2022 Oct-Dec.

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case

Erik Baltaxe  1 , Isaac Cano  2   3 , Raquel Risco  2   4 , Raquel Sebio  2   5 , Fernando Dana  4 , Sara Laxe  5   2 , Ramon Martínez  6 , Fernando Ozores  7 , Josep Roca  2   3   8 , Graciela Martínez-Pallí  2   3   4
Affiliations
Case Reports

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case

Erik Baltaxe et al. Int J Integr Care. .

Abstract
in English, Catalan

Introduction: The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016-2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilitate site transferability.

Methods: An implementation research approach with a population-based orientation, combining experience-based co-design and quality improvement methodologies, was applied. We undertook several design-thinking sessions (Oct-Nov 2017, June 2021 and December 2021) to generate and follow-up a work plan fostering service scalability. The implementation process was assessed using the Comprehensive Framework for Implementation Research, leading to the identification of key performance indicators.

Discussion: Personalization and modularity of the intervention according to patients' surgical risk were identified as core traits to enhance patients' adherence and value generation. A digitally enabled service workflow, with an adaptive and collaborative case management approach, should combine face-to-face and remotely supervised sessions with intelligent systems for patients' and professionals' decision support. The business model envisages operational costs financed by savings generated by the service.

Conclusions: Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability.

Introducció: La bretxa eficàcia-efectivitat limita l’adopció de serveis d’atenció integrada amb suport digital. L’estudi descriu el procés de co-creació efectuat (2016–2021) per desplegar, a l’Hospital Clínic de Barcelona, un servei de prehabilitació de pacients de risc per a procediments quirúrgics, amb l’objectiu d’aconseguir una adopció sostenible del servei i facilitar-ne la transferibilitat.

Mètodes: Es van aplicar eines de recerca d’implementació amb una orientació poblacional, combinant metodologies de codisseny basades en l’experiència i de millora de la qualitat. Es van realitzar diverses sessions de design-thinking (Octubre-Novembre de 2017, Juny de 2021 i Desembre de 2021) per generar, i fer el seguiment, d’un pla de treball concebut per assolir escalabilitat del servei. El procés d’implementació es va avaluar utilitzant el Consolidated Framework for Implementation Research (CFIR), que va conduir a la identificació d’indicadors clau de rendiment.

Discussió: La personalització i la modularitat de la intervenció segons el risc quirúrgic dels pacients es van identificar com a trets bàsics per millorar l’adherència i la generació de valor. La organització de la prehabilitació, amb un enfocament adaptatiu i col·laboratiu de gestió de casos, hauria de combinar sessions presencials i supervisades remotament amb sistemes intel·ligents de suport a la decisió per a pacients i professionals. El model de negoci preveu que els costos operatius de la prehabilitació siguin finançats per l’estalvi generat.

Conclusions: El procés de co-creació, combinant metodologies adequades i un marc d’avaluació estructurat, va esser clau per abordar els reptes associats a l’adopció sostenible del servei, així com la seva escalabilitat i transferibilitat.

Keywords: co-creation; mHealth; mindfulness; nutritional optimization; physical activity; prehabilitation.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Hospital Clinic de Barcelona prehabilitation service implementation time-frame
Figure 1
Timeline for co-creation and adoption of prehabilitation at HCB. Distribution of tasks through the experience-based co-design and quality improvement implementation research process; DT: Design-Thinking.
See this image and copyright information in PMC

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