As the European population ages and at the same time live longer, the number of patients with chronic diseases will also likely increase. As these types of diseases requires an extensive amount of supervision in order to keep the development of the diseases stabile, the European Commission have appealed to the member states to come up with potential solutions for the coming common challenges.
From a Danish perspective, the health care system are changing by bringing the health care system closer to the citizens. Parts of the services are to be transferred from the regions to the municipalities, and as new tasks come up, the demand for solving problems in new ways are increasing. Following, the LEON-principles guides the current intention in the municipalities to, among other elements, work preventive in order to limit hospitalization time. As a result the new term “close health service” refers to the fact that, politically, it has been decided that the municipalities have to implement home monitoring for patients with chronical lung disease (KOL) in 2019. In 2015 two large scale evaluations on home monitoring are available, TeleCare Nord and the KIH projects, and forms the backbone of the political decision.
The first part of the thesis accounts for the reasoning behind, as well as the future requirements for, the close health services. Following, in the second part of the thesis the knowledge base of the evaluations of the KOL telemedicine projects are investigated and evaluated finally recommendations are given as to how these earlier studies can help in enabling the implementation strategies of new telemedicine positioned KOL projects in the municipalities.
To investigate this, this thesis applies content analysis to explain the concepts and identified tasks underlying “close health service”. In the 2nd part evaluation, theory is used in the form of identifying proper analytical models and methods. Particular, “Guideline for Good Evaluation Practice in Health Informatics” (GEP-HI) and “Model for Assessment of Telemedicine” (MAST) is included as the framework of the analysis of the evaluation reports, specifically to analyse the knowledge as well as the learning processes, which can support implementation processes in the municipalities.
The results of the thesis have two specific implications. First, extant literature on home monitoring shows very differing effects – even opposing. This is especially true concerning the assessment of the economic impact. In conclusion, the implementation of home monitoring does not seem to create the gains initial identified. It is particular unclear, which KOL-patients are to be included, and how to deal with patients not accepting to receive home monitoring. From a prevention perspective, this could result in unequal treatment of patients. A large part of the KOL-patients that is to be included in home monitoring, are unknown for the home health care provider, effectively creating an expansion of the task portfolio for the municipality. Following, it can still be observed that a large gap exists in between the collaboration of doctors, hospitals and municipalities. As the plans of the municipalities concerning home monitoring are not advancing at a fast enough pace, compared to the increasing rate of patient discharge, this gap is predicted to increase with time. Second, this thesis place emphasis on the difficulties of combining scientific development and politics to create learning with the potential to create value in new and emerging projects. Finally, this report suggests a framework utilizable for pre-analysis to implementing KOL home monitoring in the Danish municipalities.