What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services.
What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services.
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DOI：
10.1186/s12916-015-0279-6
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发表时间：
2015-04-23
期刊：
影响因子：
9.3
通讯作者：
Rouncefield M
中科院分区：
文献类型：
--
作者：
Greenhalgh T;Procter R;Wherton J;Sugarhood P;Hinder S;Rouncefield M
我们试图定义远程医疗和远程护理的质量，旨在提高获得适当、可接受和可行的技术和服务的患者比例，以支持他们患病或残疾。这是一个三阶段的研究：（1）与7个技术供应商和14个服务提供商的访谈，（2）对40名60至98岁的多发病和辅助生活需求的人进行人种学案例研究，（3）10个共同设计研讨会。在第一阶段，我们探讨了采用远程医疗和远程护理的障碍。在第二阶段，我们使用人种学方法来建立参与者生活，疾病经历和技术使用的详细图片。在第三阶段，我们将使用者及其照顾者与供应商和提供者聚集在一起，制定辅助技术产品和服务的质量原则。访谈确定了顺利引进和继续支持辅助技术的实际，物质和组织障碍。多重发病的特点是多重的，相互加强和无情地恶化的损害，产生不同的和独特的护理挑战。参与者和他们的照顾者务实地管理这些，获得技术和适应家庭。安装的技术很少适合目的。技术支持服务对用户提出了很高的要求（有时是苛刻的要求）。研讨会提出了六项原则。高质量的远程保健或远程护理是：1）锚定在对用户重要性的共同理解上; 2）对疾病的自然史是现实的; 3）与用户共同创造、发展和适应解决方案; 4）人，通过人际关系和社交网络得到支持; 5）集成，通过关注相互意识和知识共享; 6）致力于推动系统学习。技术进步很重要，但必须得到工业和服务提供者的支持，采用以用户为中心的设计和交付方法。为了实现ARCHIE原则，该部门需要：（1）将重点从产品转移到（“辅助技术”）对业绩的影响（2）委托模式从标准化向个性化家庭护理合同的转变;以及（3）从“围墙花园”的设计模式的转变，从品牌产品到可跨设备和平台灵活组合和使用的可互操作组件。请参阅相关文章：http://dx.doi.org/10.1186/s12916-015-0305-8。
We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability. This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants’ lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services. Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning. Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and delivery. For the ARCHIE principles to be realised, the sector requires: (1) a shift in focus from product (‘assistive technologies’) to performance (‘supporting technologies-in-use’); (2) a shift in the commissioning model from standardised to personalised home care contracts; and (3) a shift in the design model from ‘walled garden’, branded products to inter-operable components that can be combined and used flexibly across devices and platforms. Please see related article: http://dx.doi.org/10.1186/s12916-015-0305-8.
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