Projects

Abstract

The Value@home project aims to create an integrated cost overview as a basis for coordinated and sustainable palliative care. As a pilot study accompanying the ‘Palliativverbund Bern’, or Bern palliative care network, it links cost data from acute wards, long-term care, hospice and Spitex/home care and identifies gaps in the data. The backdrop here is the growing need for care: the percentage of those over 65 is set to rise from 19% to over 26% by 2050. Many of those affected wish to stay at home until the end, but specialised palliative care is often provided late and predominantly in hospital, which contributes to gaps in care, hospitalisations and high costs. The EFAS proposal (standardised financing of benefits proposal) adopted in 2024 is also intended to reduce misaligned incentives.

Project manager

Dr Monika Hagemann, Scientific Researcher in End of Life Care, Center for Palliative Care, University Hospital, Insel Gruppe AG and University of Bern

Project participants

Steffen Eychmüller (Inselspital), Maud Maessen (Inselspital), Georgette Jenelten (Spitex Bern), Ursula Hafed (Wohn and Pflegeheim St. Niklaus Koppigen), Sibylle Jean-Petit-Matile (Stiftung Hospiz Zentralschweiz), Matthias Schwenkglenks (University of Basel), Manuela Weichelt (Palliative.ch)

Abstract

COALA studies how digital orchestration can close gaps in care and make regional services more visible. Demographic change, shortage of healthcare professionals and rising healthcare costs are straining the healthcare system, while the fragmented system of medical, nursing and social services remains difficult to navigate for those affected. Research data on the effectiveness of digital information platforms is lacking, and existing solutions tend to focus primarily on medical care or isolated tools. COALA is therefore developing a platform concept and testing it with two regional health networks to examine acceptance, user-friendliness and efficiency potential. Building on the Caro1 Care Organizer, COALA is creating a cross-sector platform for the further development of Care@home.

Project manager

Wolfgang Rieder, Project Manager/Development Engineer Switzerland Innovation Park Biel-Bienne

Project participants

Emma Nadol (SCDH), Michaël Laurac (BFH), Peter Bodziak (Gesundheitsnetzwerk Oberaargau), Martin Jörg-Gygax (Healthinal AG), Stefan Steiner (Verein Smarthöfe), Claudia Monstein (Healthinal AG)

Abstract

This project lays the groundwork for a new blended nutrition therapy that combines personal and digital nutritional advice for malnourished patients after being discharged from the hospital and thus closes a gap in care in an innovative way. Malnutrition affects around 40% of hospitalised individuals and leads to weight loss, muscle reduction, vulnerability, and a risk of falling and increased hospitalisation. Although nutritional therapy reduces readmissions and improves quality of life, targeted nutritional follow-up care in the home environment is rarely provided in Switzerland. The pilot project optimises care through practical implementation as well as interviews and workshops with participating institutions, and identifies technological, logistical and economic hurdles. A follow-up project is intended to implement the dual therapy and roll it out nationally.

Project manager

Dr Raphael Banz, Co-Founder, Chief Scientific Officer, Omanda AG

Project participants

Dr Undine Lehmann (BFH), Dr Marvin Grossmann (Inselspital), Dr Matthias Schlögl (Barmelweid Clinic), Dr Katharina Blankert (BFH), Eveline Zbären (Omanda AG)

Abstract

The first part of the project establishes what needs to be taken into account in the living environment in order to effectively support C@h patients, thereby closing a central gap in current discharge planning, which usually only considers the immediate living situation. However, the broader living environment is also crucial for identifying support needs early and avoiding readmissions. Another fundamental problem concerns nutrition: protein-energy malnutrition is widespread among people over 65 and particularly increases the risk of hospital readmissions in chronically ill patients or after visceral surgery. The second part therefore examines how nutrition problems can be better identified and addressed by healthcare professionals.

Project manager

Tannys Helfer, Research Associate, Applied Research and Development in Nursing, (Innovation Field Psychosocial Health), BFH

Project participants

Heiner Baur (BFH), Áron Korózs (BFH), William Fuhrer (BFH), Jerylee Wilkes-Allemann (BFH), Christine Wenger (SVDE ASDD), Ruth Hagen (Spitex Switzerland), Nadine Habegger (Spitex AemmePlus AG), Emma Nadol (SCDH)

Abstract

The CoPEER project complements the existing Care@home provision of psychiatric home care with low-threshold peer-to-peer support for clients and their relatives. Mental health issues are among the most common chronic conditions, and many sufferers experience loneliness, reduced social activities and everyday strains despite professional care. Relatives also often report exhaustion and psychological stress. Studies show that peer support can strengthen hope and self-efficacy and reduce loneliness as well as symptoms of illness. CoPEER connects clients and relatives with other affected parties through a digital platform, thereby creating a bridge between professional care and self-management as well as timely access to support.

Project manager

Dr Anna Hegedüs, Co-Head of the Innovation field ‘Mental Health and Psychiatric Care’, BFH

Project participants

Nora Ambord (BFH), Chantal Kuske (Restful), Raphael Reber (Restful), Sonja Forster (Spitex Kriens)

Abstract

The prevalence of cancer in Switzerland is increasing. Relatives often take on central caregiving responsibilities, yet are under considerable strain. This leads to increased stress and mental health problems, particularly among relatives of patients in the palliative stage. Access barriers such as low socio-economic status or residence in rural areas make it more difficult to access support services. The project aims to develop a digital e-health application that provides psychosocial support to family members, reduces stress and enables low-threshold access to support services. Optimised care can prevent unnecessary hospital admissions and ensure comprehensive healthcare provision in both urban and peripheral regions.

Project manager

Prof. Alexander Wünsch, Head of Psycho-oncology, Inselspital, University Hospital Bern

Project participants

Dr Monica Fliedner (Inselspital), Georgette Jenelten (Spitex Bern), Ursula Dolder (Spitex Bern), Luca Willi (AvanzaTec)

Abstract

Demographic trends pose major challenges for GPs: the growing need for decentralised support can often barely be met. Remaining in one’s own home plays an important role in palliative care – however, this often depends on family carers. Acute deterioration in the state of health often leads to uncertainty and unnecessary hospital admissions. These could be avoided through rapid contact with healthcare professionals and proactive emergency planning. Trust and safety are key factors for successful palliative care in the home environment. Our project therefore relies on the use of video consultations in outpatient specialised palliative care (SPC). Video consultations not only reduce travel times but also offer targeted support to patients with reduced mobility. Relatives and patients are trained in the clinical setting in the use of a digital communication tool, which can then be used at home.

Project manager

Maud Maessen, postdoc, University Centre for Palliative Care, Inselspital, University Hospital Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern

Project participants

Prof. Steffen Eychmüller (Inselspital), Dr Monica Fliedner (Inselspital), Dr Julia Rehsmann (BFH), Sabrina Gröble (BFH)

Abstract

One of the biggest challenges in the Care@home setting is nutrition management. Inadequate nutrition management can promote malnutrition, which leads to serious health consequences such as increased complication rates, longer hospital stays and more frequent readmissions. At the same time, it places a burden on patients and family carers and reduces quality of life. Barriers such as lack of time, lack of guidelines, inadequate communication and insufficient awareness make interprofessional nutrition management in the outpatient setting more difficult. The aim of this project is to identify such barriers and develop innovative, practical solutions. Needs are identified, the current status of the nutrition management analysed and digital and interprofessional support options discussed in a workshop.

Project manager

Dr Andine Lehmann, Head of Degree Programme MSc Nutrition and Dietetics, lecturer, Senior Scientist, Nutrition and Dietetics Division, School of Health, Bern University of Applied Sciences

Project participants

Katja Uhlmann (BFH), Sara Maria Hägi (FresuCare AG), Daniel Reichenpfader (BFH), Raphael Banz (Omanda)

Abstract

There is a lack of evidence-based knowledge regarding the social and spatial factors that influence successful Care@home provision, as well as a lack of tools for assessing home environments. Interprofessional cooperation between inpatient care and outpatient care is often uncoordinated, causing gaps in care and duplication. Patients and relatives generally bear the burden of complex coordination, often without sufficient knowledge of available options. Early hospital discharges frequently give rise to follow-up care problems that favour readmissions and may be exacerbated in the Care@home setting. The aim of the project is the participatory development of a tool that allows Care@home to be set up at an early stage and in a person-centred manner, taking into account social, spatial and professional requirements and avoiding care gaps as much as possible.

Project manager

Franziska Scheidegger-Balmer, Research Associate, Institute on Ageing and Applied Research and Development Nutrition & Dietetics, School of Health, Bern University of Applied Sciences

Project participants

Regula Blaser (BFH), Eva Soom Ammann (BFH), Tanny Helfer (BFH), Simon Schrämli (Spitex ReBoNo), Georgette Jenelten (Spitex Bern), Marion Burgener (Spitex Region Thun AG), Sabine Molls (Inselspital)

Abstract

Switzerland is facing the challenge of an ageing population and increasing demand for home care, especially for people with dementia. With around 30,400 new cases annually, of which 5,000 are in the canton of Bern, the need for innovative care models is growing. The aim of the project is to improve care by analysing coordination problems and communication gaps and by developing a prototype for integrated dementia care. This lightens the burden on relatives and supports healthcare professionals. Improved cross-professional service coordination closes knowledge gaps and enables Care@home Bern to take a pioneering role in cross-sectoral care and to optimise support.

Project manager

Dr Minou Afzali, Head of Research, Swiss Center for Design and Health GmbH

Project participants

Dr Heinz Locher (Care at Home Schweiz GmbH), Dr Kosta Shatrov (Spitex Switzerland), Esther Bättig (Spitex Switzerland), Prof. Sang-Il Kim (BFH)

Abstract

Roughly four per cent of the population are affected by long Covid. To date, the healthcare system has not been sufficiently prepared or coordinated to provide the best possible support for those affected and their families. Studies show that additional structures and services are needed to ensure adequate, person-centred care. Digital health interventions such as apps, telemedicine and therapy platforms could improve access and networking as well as relieve healthcare professionals. However, there is a lack of data on the use of these services by those affected and by professionals. This project examines the accessibility, acceptance, safety, effectiveness and usability of digital interventions as well as enabling factors and barriers. The goal is to formulate recommendations for future developments and to optimise the provision of care.

Project manager

Prof. Mirjam Körner, Head of the Competence Center for Interprofessionalism, Co-Head of Degree Programme MSc Healthcare Leadership, School of Health, Bern University of Applied Sciences

Project participants

Prof. Maya Zumstein-Shaha (BFH), Kerstin Denecke (BFH), Chantal Britt (BFH), Karin Van Holten (BFH), Kimet Rashiti (Spitex Thun), Dominic Gorecky (SIPBB), Wolfgang Rieder (SIPBB)

Abstract

The Rehabio project aims to improve older people’s quality of life and mobility through a digital companion application. It combines telemedicine and telephysiotherapy to enable personalised care and monitoring as well as to promote communication between patients, healthcare professionals and nursing facilities. In view of rising fall-related injuries (+38% by 2034) and inadequate prevention methods, Rehabio addresses the consequences of recurring falls and the strain on medical staff. The project strengthens prevention after rehabilitation by empowering older people to participate actively in their own healthcare.

Project manager

Prof. Johannes D. Bastian, Chief Physician, Head of Orthogeriatrics, Co-Head of the Hip and Pelvis Unit, University Clinic for Orthopaedic Surgery and Traumatology, Inselspital

Project participants

Silviya Ivanova (Inselspital), Prof. Heiner Baur (BFH), Prof. Slavko Rogan (BFH), Chris Gugl (Evoleen AG), Marcel Wüthrich (Evoleen AG), Sophia Mardin (Evoleen AG)

Abstract

This project examines the financing and remuneration of Care@home models in Switzerland with a view to developing sustainable structures for high-quality and cost-efficient health services. Currently, C@h models that combine inpatient and outpatient care during acute periods of illness are mostly funded only through pilot projects. There is a lack of a uniform definition of C@h services, clear remuneration models and integration into the healthcare system. The project analyses existing models, cost structures and international approaches. The goal is to develop recommendations for the long-term financing and integration of C@h in Bern in order to improve patient care and make the healthcare system more efficient.

Project manager

Dr Katharina Blankart, Head of the Institute of Health Economics and Health Policy, School of Health, Bern University of Applied Sciences

Project participants

Dr Kosta Shatrov (Spitex Switzerland), Esther Bättig (Spitex Switzerland), Severin Pöchtrager (Swiss Hospital at Home Society), Eva Blozik (SWICA)

Link zum Projekt

Financing and reimbursement of Care@home

Abstract

Perinatal mental health conditions represent a significant health problem worldwide. The prevalence in Western industrialised countries is 20%. In Switzerland, roughly 17% of mothers are affected. Timely interventions are crucial in minimising negative consequences. Guidelines recommend avoiding separation of the mother and child in cases where treatment is necessary and advocate for targeted measures to strengthen the mother-child bond. The limited availability of psychiatric clinics offering mother-child placement in Switzerland, and barriers to access such as long waiting times and lack of childcare, were identified as problems. Home care has the potential to reduce barriers and promote family cohesion. The project aims to develop and implement an interprofessional Care@home service for the postpartum period in order to improve timely access for persons affected by perinatal mental health conditions.

Project manager

Kristina Adorjan (UPD)

Project participants

Lena Sutter (Women’s Clinic, Inselspital), Eva Cignacco (BFH), Sebastian Walther (UPD), Franziska Schlensog-Schuster (UPD), Anna Hegedüs (BFH), Jessica Soldati (Inselspital), Annika Redlich (Periparto Switzerland), Holger Litzenburger (Swiss Center for Design and Health SCDH AG)

Link to the project

Enhancing timely access to acute psychiatric care@home for women after birth

Abstract

Hospital at Home (HaH) is a new form of care for Switzerland that is intended to promote patient autonomy. It is still unclear which indicators are suitable to represent and evaluate the quality, safety, satisfaction and cost efficiency of HaH models. Building on workshops and close dialogue between BFH, the Swiss Hospital at Home Society (SHaHS) and three active HaH providers (Klinik Arlesheim, Zolliker Hospital, Hospital@Home-AG), concepts for generating comparable data will be developed (based on the existing design of a minimal data set, among other sources). In addition, requirements for technologies to ensure an optimal flow of information will also be gathered. The goal is to pilot and implement evaluation and quality assurance concepts in third-party-funded projects, with a view to defining the conditions for the success of the HaH form of care and to contributing to its integration in the Swiss healthcare system.

Project manager

Caroline Schneider (BFH)

Project participants

Severin Pöchtrager (Swiss Hospital at Home Society SHaHS), Werner Vach (Research SHaHS working group), Tobias Müller (BFH), Thomas Bürkle (BFH), Friederike J.S. Thilo (BFH)

Link to the project

Hospital at Home care models – evaluation and quality assurance

Abstract

In patients with chronic illnesses, improving activity and participation is the primary focus of inpatient rehabilitation. After around three weeks of therapy and care, the patients are discharged to their home environment whenever possible. Due to the challenges of everyday life, lifestyle-change goals can easily fall down the priority list. Deterioration of the illness and readmission to the hospital are possible consequences. Artificial intelligence and large language models like GPT-4 have the potential for scalable yet highly individualised e-health applications. A Reha@home care model that uses such an application is intended to optimise the transition from inpatient to outpatient settings and thereby prevent readmissions.

This project aims to: 1) investigate the need for a Reha@home model after inpatient rehabilitation; 2) demonstrate, by way of examples, how language models could be integrated; 3) determine the current limits of implementation.

Project manager

Thimo Marcin (Berner Reha Zentrum)

Project participants

Matthias Wilhelm (Zentrum für Rehabilitation und Sportmedizin), Kai-Uwe Schmitt (Academy-Practice-Partnership BFH – Insel Group), Undine Lehman (BFH), Karin Haas (BFH), Barbara Solenthaler (Department of Computer Science ETH Zurich), Rafael Wampfler (Department of Computer Science ETH Zurich)

Link to the project

RehaBot – AI as an interface between patients and reha professionals

Abstract

The density of primary care provision is decreasing, particularly in rural areas. This is due in part to the drastic decline in GP practices, as well as to the increase in part-time employees who perform little to no weekend or night work. As a result, routine visits to the GP are becoming less common. In order to ensure good outpatient primary care in the future as well, this project is looking for alternatives. The use of new telemedicine services could alleviate the shortage of healthcare professionals and promote interprofessional cooperation. New laboratory diagnostics in combination with a health data platform accessible to all stakeholders could be an important key to success. One specific use case is GP visits to nursing homes by hospital employees. Individual pilot projects, including one in the Emmental, are taking a pragmatic approach to this issue and are already making use of telemedicine technologies. A comprehensive assessment and analysis of the critical care situation, accompanied by specific, actionable proposals for solutions, is currently still lacking.

Project manager

André Leuenberger (Post CH Kommunikation AG)

Project participants

Robert Escher (Spital Emmental), Thomas Bürkle (BFH), Theodor Wilhelm (Post-Sanela Health AG), Michael Flynn (Roche Diagnostics International AG)

Abstract

Electronic medical devices that use artificial intelligence (AI) to predict acute heart failure (AHF) can help care for affected patients and avoid hospital stays and readmissions. This project evaluates the feasibility of remote monitoring using AI algorithms and examines the satisfaction of patients and healthcare professionals. The pilot study will include AHF patients who are admitted to the emergency department or medical ward and discharged home with WARD-CSS devices (predictive AI tool for early warning of deterioration) for monitoring. In this way, the project team collects pilot data that will enable it to apply for additional funding for a prospective, randomised trial to demonstrate the effectiveness of remote monitoring of AHI patients using AI in home care.

Project manager

Maria Wertli (Inselspital, UniBE, KSB)

Project participants

Marco Fernandes (Réseau de l’Arc), Aurore Maggiotto (Réseau de l’Arc), Muriel Maeder (Réseau de l’Arc), Christian Meyhoff (Wireless Assessment of Respiratory and Circulatory Distress WARD)

Abstract

Within the framework of this project, a service blueprint is being created for the Swiss Care@home initiative. A service blueprint is a visual analysis of the current situation that represents the interplay of various service components (people, tools, processes). Currently, there is a lack of a uniform C@h body of knowledge in Switzerland. Many health organisations develop their own concepts in isolation, with experience and knowledge mostly shared internally. There is a lack of best practices and accessible information. The aim of the project is to analyse information processes at various C@h providers and to provide insights for all stakeholders. This supports the development and sustainability of such models and lays the groundwork for a follow-up project. The planned follow-up project involves the development of a C@h learning platform to minimise uncertainty among patients, optimise the continuing education of healthcare professionals and strengthen trust in new forms of treatment.

Project manager

Minou Afzali (SCDH AG)

Project participants

Sereina Soldner (hospitales – wir ermöglichen hospital at home), Sang-Il Kim (BFH), Bernhard Probst (LerNetz AG), Emma Nadol (SCDH AG), Sulayla Karadeniz (BFH)