A data-driven but person-centered assessment framework for sustainable rehabilitation services

Abstract

Utilization of data and information technologies is one of the expectations for the future in a health care domain. Although electronic health records are used in decision making for medical prescription in many hospitals, small nursing care providers are not able to effectively utilize data. We aim at development of an online rehabilitation service that utilizes data both for designing a rehabilitation plan for each patient and for a sustainability of the service. This paper presents a framework for the assessment of the rehabilitation that is data-driven but person-centered.According to the International Classification of Functioning, Disability and Health (ICF), in designing a rehabilitation plan, it is important to consider not only the maintenance and improvement of physical functions of a patient's body, but also his/her activities related to tasks and actions in a daily life and the participation or involvement in his/her life situation. Each patient has his/her own background in needs for the rehabilitation thus we focus on the person-centered care approach where a health care should be based on the unique person's needs. The rehabilitation plan should focus on the abilities of the person and encourage activity even though the data is actively used.The proposed assessment framework consists of a part for evaluating the effect of rehabilitation and that for extracting problems in operation of the online rehabilitation service. The part of rehabilitation effect evaluation is based on Japanese version of the Cardiovascular Health Study frailty index: weight loss, slow gait speed, low physical activity, exhaustion, and low grip strength. The part also includes questionnaire-based indices of subjective happiness and willingness for social activities. On the other hand, the part of the problem extraction for a sustainable operation of the service includes an interoperability between the nursing facility site and the patient's home in terms of an online service connecting them for a video-based rehabilitation exercise. The part is based on the questionnaires and interviews for workers at the nursing facility as well as those for the patient and family.In this case study, we introduce an example of the proposed framework at the step of a service design and discuss how to apply it to the service operation step. In a rehabilitation service domain, neither the data distribution platform nor the data bank is currently in operation. However, a rehabilitation assessment system utilized the platform and data bank would be in service in the future. For a sustainability of the service, it is important to successfully integrate data, technologies, and human as a stakeholder. In this paper, we also discuss a person-centered design for the integration with a focus on considering life backgrounds and sense of values of the patient as well as his/her home environment and risk management for the rehabilitation exercise.