CLOSE is one of the first EIT Health Innovation Projects and developed and deployed integrated solutions (APplus) centered on closed-loop metabolic control by means of an artificial pancreas (AP) for people with diabetes.
APplus comprises a product and service package complementing the AP by obligatory training as well as home visits and telemedical consultations on demand. Outcome predictors and performance indicators shall help to identify people who could benefit most from AP use and facilitate the measurement of AP impact in diabetes care. CLOSE established a scalable AP+ model case working at the interface between patients, homcare service providers, and payers in France. CLOSE will then scale up APplus by pursuing geographic distribution, targeting additional audiences and by enhancing AP functionalities and interconnectedness.
By being part of the EIT Health public-private partnership, CLOSE is committed to the EIT “knowledge triangle” pursuing the integrated advancement of technology, education and business creation. Putting stakeholders, education, and impact into the center of APplus advancement is considered key for achieving a wide AP use in diabetes care.
CLOSE stands for an EIT Health innovation project designed to overcome barriers to a wide-scale marketing of artificial pancreas (AP) systems for diabetes care. A key objective of CLOSE is to develop superior risk-benefit and cost-benefit scenarios for AP operation thereby achieving a positive acceptance by users and caregivers and a high eligibility for reimbursement. To meet this objective CLOSE will put the AP into the center of comprehensive APplus product and service packages specifically tailored to the needs and requirements of defined type 2 diabetes (T2D) patient groups and care environments.
APplus product and service packages complement the AP system by obligatory training as well as home visits and telemedical consultations on demand. Outcome predictors and performance indicators shall help to identify people who could benefit most from AP usage and facilitate the measurement of AP impact on health, care operations, and costs. A multi-stakeholder approach engaging in a continuous dialogue with users, healthcare providers and other stakeholders in diabetes care is going to inform the design and validation of APplus solutions.
Initially CLOSE follows a co-creative approach by developing an APplus paradigm at the heart of French homecare service provision targeting severely ill people with T2D. French homecare service provider operate fully integrated chronic care platforms at the cross-roads between patients, health professionals, payers, and prescribers while using proven methods and processes being based on established policies. By establishing a French APplus paradigm case CLOSE will prove a safe and cost-effective AP usage in a real-world healthcare scenario.
Enabling a massive and multi-dimensional APplus scalability is another key objective of CLOSE. Using homecare as a starting point and learning lab APplus can be easily adapted to additional patient groups and care environments. The geographic scalability will benefit from a careful consideration of existing local/national competencies and healthcare structures. A train-the-trainer approach to efficiently develop and maintain a network of professionals delivering trainings to those installing, operating, and monitoring AP+ operation will guarantee a safe and cost effective operation of AP+ wherever. Converging with other strands of health innovations functionally enhanced and interconnected AP systems will contribute to a fully integrated personalised diabetes management. Following the triple aim approach to optimizing the sustainability of healthcare a wide AP implementation in diabetes care should improve the interactions of the individual patients’ care experience, the health of the respective patient population, and the per capita healthcare costs, thereby making the AP attractive also for usage within the scope of pay-for-performance models.
Figure 1: The artificial pancreas (AP) core system approaches a “technical cure” of diabetes by closing the loop between blood glucose levels and insulin infusion when the continuous subcutaneous insulin infusion (CSII) rates are varied by a control algorithm (CONT) taking changes in glucose levels into account. The algorithm can be implemented in a smart phone. The communication between the components can be established via Bluetooth. Real-time glucose levels are measured continuously in the interstitial fluid by a glucose sensor (CGM).
Figure 2: APplus product and service package for people with T2D on homecare (French APplus paradigm). APplus comprises the AP, obligatory training and education modules, and a panel of outcome predictors and performance indicators helping to identify patients who might benefit most from AP usage and to measure the impact of AP usage on the quality and effectiveness of diabetes care.
The CLOSE EIT Health innovation project is executed by a partnership which has been established under the umbrella of EIT Health. CLOSE partners hold key capabilities in healthcare service provision, AP development, education & training, performance measurement as well as market implementation and advancement of diabetes technologies. In addition expertise in healthcare research, economic modelling, and the development of performance measurement instruments is available within the partnership. CLOSE receives valuable advice from the CLOSE advisory board members Prof. Dr Eric Renard (Centre Hospitalier Universitaire de Montpellier, Department of Endocrinology, Diabetes and Nutrition) and Prof. Dr Lutz Heinemann (Profil GmbH).
EIT Health’s CLOSE project detailed in “Journal of Diabetes Science and Technology”
“EU-funded R&D partnerships in healthy living and active ageing”
Best Practice for Diabetes Patients: CLOSE Project Receives Positive Evaluation
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