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Download and Use Disorders and Disabilities in Need of Regular Follow up the Platform and Verify That the Conditions for an Effect- Multidisciplinary Assessments Mercuri et al. Italian Journal of Pediatrics (2021) 47:29 https://doi.org/10.1186/s13052-021-00975-z RESEARCH Open Access Contactless: a new personalised telehealth model in chronic pediatric diseases and disability during the COVID-19 era Eugenio Mercuri1,2,3* , Giuseppe Zampino1,3,4,5, Alisha Morsella1,6, Marika Pane1,2,3, Roberta Onesimo3,4,5, Carmen Angioletti1,6, Piero Valentini1,3,4, Claudia Rendeli1,3,7, Antonio Ruggiero1,3,8, Lorenzo Nanni1,3,9, Antonio Chiaretti1,3,4, Giovanni Vento1,3,10, David Korn3,4, Emilio Meneschincheri11, Paolo Sergi11, Giovanni Scambia1,3,12, Walter Ricciardi1,3,13, Andrea Cambieri14 and Antonio Giulio De Belvis1,6 Abstract Background: Suspending ordinary care activities during the COVID-19 pandemic made it necessary to find alternative routes to comply with care recommendations not only for acute health needs but also for patients requiring follow-up and multidisciplinary visits. We present the ‘Contactless’ model, a comprehensive operational tool including a plurality of services delivered remotely, structured according to a complexity gradient, aimed to cover diagnostic procedures and monitor disease progression in chronic pediatric patients. Methods: A multidisciplinary and multiprofessional project team was recruited, in collaboration with patients’ associations, to map a panel of available Evidence-Based solutions and address individual needs in full respect of the concept of personalized medicine. The solutions include a number of services from videoconsultations to more structure videotraining sessions. Results: A modular framework made up of four three Macro-levels of complexity - Contactless Basic, Intermediate and Advanced - was displayed as an incremental set of services and operational planning establishing each phase, from factors influencing eligibility to the delivery of the most accurate and complex levels of care. Conclusion: The multimodal, multidisciplinary ‘Contactless’ model allowed the inclusion of all Units of our Pediatric Department and families with children with disability or complex chronic conditions. The strengths of this project rely on its replicability outside of pediatrics and in the limited resources needed to practically impact patients, caregivers and professionals involved in the process of care. Its implementation in the future may contribute to reduce the duration of hospital admissions, money and parental absence from work. * Correspondence: [email protected] 1Pediatric Neurology Unit, Fondazione Policlinico A Gemelli –IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy 2Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli –IRCCS, Rome, Italy Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Mercuri et al. Italian Journal of Pediatrics (2021) 47:29 Page 2 of 7 Introduction Diseases, Pediatric neurology, Neuromuscular and Spina The COVID-19 pandemic has posed an unprecedented Bifida Units, along with general pediatric oncology and challenge to health systems and activated a timely re- pediatric surgery. Most patients require a broad range of sponse on behalf of governments and healthcare facil- services, from simple health-status checks to high com- ities. Many nations worldwide have responded by plexity levels of care, and support for families who play a promptly reorganizing hospitals. Most resources were vital role in disease management and surveillance. reserved for emergency care and for the development of The purpose of the Contactless Project was to fill the COVID-19 units while, at the same time, limiting access gaps between simple video-consultations and more so- to healthcare facilities for routine or elective activities, phisticated telemedicine requiring the use of multimodal reducing the risk of spreading COVID-19 [1]. During devices by identifying a number of intermediate steps. the first months of the pandemic, severely affected coun- These included video tutorials and questionnaires deliv- tries had no choice but to cancel all elective surgeries, ered through remote interaction between the young pa- follow-up appointments, rehabilitation services [2]. This tients and their parents or guardians to ensure pressurized physicians and patients to find alternative continuity of care at different levels of complexity. ways to comply with care recommendations, especially This article aims to describe a comprehensive in patients with chronic diseases, who require regular organizational model that can provide the multiplicity of follow up assessments and of a multidisciplinary ap- pediatric services through remote interaction with the proach to prevent complications caused by underman- families utilizing appropriate technologies with full respect agement [3]. The challenge was to find alternative ways for their privacy. We also report the development of this to continue treatment while maintaining safety mea- process, from design and personalization of the service to sures. As an immediate response, physicians found needs assessment and implementation planning. themselves obliged to find quick-fixes to assist their pa- tients remotely using informal telephone consultations Methods and video-calls on disparate Apps [4]. This however A multidisciplinary and multiprofessional project team could only be seen as an ‘emergency’ short term solution of administrative and clinical Units of our institution, as it could not replace the quality of care previously pro- was recruited combining the expertise of the different vided and was not fully compliant with the protection of FPG-IRCCS’ Pediatric Units, Information Communuca- privacy. As the weeks passed, innovative digital devices tion Technology Directorate, Data Protection Office, [5], which had been slowly making their way into the Marketing Unit, and Critical Pathways and Outcome market before the pandemic, paved the road for more Evaluation Unit which also provided organizational and advanced forms of remote care and surveillance and, as managerial support. emergencies often do, the shift to telemedicine became A literature search mapped Evidence-Based services one of the priority of the COVID-19 era [6]. currently available in Telehealth in pediatric care. In the Telehealth, a term used interchangeably with telemedi- absence of structured models applicable to our needs, cine, has been defined as the use of medical information the Pediatric Department’s clinicians conducted a needs that is exchanged from one site to another through elec- assessment to estimate which aspects of care to tronic communication to improve a patient’s health [7]. prioritize, and the volumes of the target population eli- This generally implies the use of multimodal devices that gible to the services. A comprehensive analysis of the cannot however be easily made available for immediate number and type of evaluations performed in the previ- use for large cohorts of patients. This appears to be par- ous 3 years was performed. The needs assessment ana- ticularly true for those pediatric patients in need of a lysis led to an estimated volume of 1366 patients per multidisciplinary approach that also includes rehabilita- month across the different pediatric specialties. tion, or other aspects of care that are not always covered The second phase identified which tools were needed by the available devices. There has therefore been the and the best modalities to provide the services. While need to identify a new, easily available approach, that some services could be delivered via videoconferences, would include the possibility to continue assessments more complex assessments, monitoring or interventions and training sessions normally used in the routine clin- would require the involvement of the families to perform ical assessments as part of standards of care to restore some activities. Each pediatric service established the care continuity to those who have been deprived of it. In most relevant needs and possible suggestions to ‘trans- this context, our Pediatric Department has been rapidly late’ what normally used in a clinical setting into new reorganizing the provision of its services to ensure un- tools that would enable families to perform these activ- interrupted follow-up and treatment, despite the trying ities, with the help of videotutorials, questionnaires or circumstances. Our Department includes services fo- interactive videotraining sessions. While we tried
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