ISG2010 International Society for Gerontechnology 7th World Conference Vancouver, Canada, 27-29 May 2010
Outline of a general framework for assessing e-health and gerontechnology applications: Axiological and diachronic dimensions V. Rialle*, N. Vuillerme*, A. Franco**, Y. Fouquet* *University and Universitary Hospital of Grenoble, France **University and Universitary Hospital of Nice, France French Society for Gerontechnology National Reference Center for Home care and Autonomy
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Summary
Introduction “Does
it work ? Is it useful ? Are users satisfied ?”
Analysis
Quick review of disciplines, languages, values …
Proposition
TEMSED : an evaluation framework for structuring complexity
Discussion 2
Introduction Fundamental reccurrent questions « Does it work? Is it usefulv? Are users satisfied? " How does it cost ? How and what does it spare ? Does it hurt ? Impacts on pratice ? Impacts on elders empowerment ? Etc.
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Introduction Areas of investigation
(Geron)Technology and service for ageing, social connectedness, health, autonomy… • Great number of papers, experiment reports, issues…
Evaluation • Social effectiveness, medical effectiveness, cost effectiveness, quantitative/qualitative assessment, ethnographical evaluation… • Profusion of methods • Profusion of brakes, biases, obstacles – Lot of ‘partial’ evaluations • Absolute need ! – From decision makers, health policy makers
Necessity to conduct reliable multi-dimensional evaluations to share a common language which transcends diversity
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Evaluation reports refer to: Scientific disciplines
With specific methodological approaches
Common language and assessment tools ICF Plethora of evaluation scales ans standardised questionnaires
Values
What is worth to be considered
Magnitudes
Size of the study, invested efforts, durations
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Scientific disciplines of gerontechnology
Geron - technology
(from JEMH van Bronswijk, Eindhoven University of Technology, 2008)
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Common language: International Classification of Functioning, Disability and Health (ICF)
ICF:
« (…) the international standard to describe and measure health and disability » • www.who.int/classifications/icf/en/
A common language
For referring to • • • •
Body functions Body structures Activities and participation Environmental factors
Within sudies of • Outcomes, quality of life or environmental factors
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Values - Example 1 Danish Centre for Health Technology Assessment 5
domains of « values »
• Technology • Patient • 0rganization • Economy • Ethics – Health Technology Assessment World Europe 2009 http://www.healthnetworkcommunications.com/2009/ hta/ 8
Values - Example 2 European network for Health Technology Assessment (EUnetHTA) Nine domains of values • 1. Health problem and current use of the technology • 2. Description and technical charac. of the technology • 3. Safety • 4. Effectiveness (mortality, morbidity, function, QoL, patient satisfaction) • 5. Costs, economic evaluation • 6. Ethical aspects • 7. Organisational aspects • 8. Social aspects • 9. Legal aspects – MethoTelemed: Users’ needs: Report on the results of Workshop One (oct 2009)
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Magnitude Example of the Clinical trails’ phases Pre-clinical studies
n vitro (test tube) and in vivo (animal or cell culture)
Phase 0
exploratory
Phase I
first stage of testing in human subjects; small groups
Phase II
to assess how well the drug works; on larger groups (20-300)
Phase III
randomized controlled multicenter trials; large groups
Phase IV
Post marketing surveillance trials
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Proposition
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Proposition for structuring complexity: The TEMSED approach Axiology Technology Ergonomics Medicine Society Economics Deontology
Magnitude Design: Research and development Phase I: technical aspects (reliability, robustness…) Phase II: relation between the user and the device Phase III: probing results in various terms Phase IV: economical viability and dissemination capacities
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Two main dimensions Axiology – from Greek ἀξίᾱ, axiā, "value, worth"; and -λογία, -logia). Axiology is the study of quality or value (http://en.wikipedia.org/wiki/Axiology)
Question tackled : What are the « values », in the broad sense, of the evaluation ? Includes scientific disciplines, economy, deontology…
Magnitude – from Latin magnus, "grand »; with the suffix itude
Question tackled : What is the extent (size, duration, efforts…) of the evaluation ? Includes all procedural aspects
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TEMSED
Deontology Axiology
Economics Society Medicine Ergonomics Technology
Design
Phase I
Phase II
Phase III
Phase IV
Magnitude 14
Discussion - conclusion TEMSED not a definite model stricto sensus Is not intended to provide all solutions regarding assessment methods Provides a framework Is
• For gathering complimentary assessment traditions • For helping to systematise evaluation Is
intended to be used, namely
• By the French National Reference Center for home care and autonomy (CNR SDA) • By the French Chapter of ISG May
be the summary of a vast handbook of evaluation
• to write together… 15
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Health Technology Assessment World Europe 2009 • http://www.healthnetworkcommunications.com/2009/hta/
NICE AETMIS
• www.aetmis.gouv.qc.ca
Interdisciplinarity of Gerontechnology • JEMH van Bronswijk, Eindhoven University of Technology • http://www.slidefinder.net/I/ Interdisciplinarity_Gerontechnology_2008_International_Master/ 10081151
MethoTelemed: Methodology to assess telemedicine applications (SMART 2008/0064 – O.J.2008/S 107-142555) • http://ec.europa.eu/information_society/newsroom/cf/ itemlongdetail.cfm?item_id=5038
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MethoTelemed: Users’ needs: Report on the results of Workshop One (oct 2009) • http://telemed.custompublish.com/getfile.php/ 1023659.357.bbbrftaxqx/MethoTelemed-Users_needsReport_on_the_results_of_Workshop_One.pdf
« Revue systématique des effets de la télésurveillance à domicile dans le contexte du diabète, des maladies pulmonaires et des maladies cardiovasculaires » • ETMIS 2009; VOL. 5 : NO 3 (Agence d’Evaluation de Technologies et des Modes d’Intervention en Santé).
Clinical trials (Wikipedia)
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