Bucharest Pilot: 
 Spitalul Universitar de Urgenta Bucuresti (UHB)

Description of the Pilot site

Spitalul Universitar de Urgență București (UHB) was first opened in 1978. Between 1992-1993 the hospital changed its structure and enlarged its activity becoming a university hospital. In 1994 began the consolidation of the hospital and in 1997 the Ambulatory Care Unit became a separate structure. In 2000 became an emergency hospital and in 2011 the most modern and the largest Emergency Unit in the country was opened.

At the time of the inauguration the hospital was composed of the following departments: Internal Medicine, Surgery, Neurology, Ophthalmology, Gynecology, Orthopedy-Traumatology, Intensive Care, Radiology, Anatomopathology and a Laboratory. Between 1984-2005 the medical services were diversified and new departments were opened. Nowadays, it is largest hospital in Bucharest (over 1000 beds) being a clinical unit with legal authority under the jurisdiction of the Ministry of Health.

UHB is a Public health unit assuring medical services (emergency, prevention, recovery, and palliative care) in conformity with the law 95/2006 on public health.
Since 2011 SUUB is a Category 1 regional emergency hospital with a high level of competency with more than 100000 admissions each year.

It maintains and continuously improves a Quality Management System according to requirements of international standard ISO 9001:2008.

UHB is composed of academic clinical and non-clinical units capable of providing:

  • emergency care
  • medical care and assistance
  • university activities - teaching hospital
  • clinical research
  • post-academic education

The research activity strengthens the quality of medical act, while guaranteeing patients’ rights, morals and ethics.

UHB collaborates with national and international partners to test new methods of investigation and treatment and coordinates specific interdisciplinary programs in order to implement new prevention, diagnosis, and treatment techniques in the medical field. The goal of all these programs is to improve the health status and the quality of life of the people.

The Neurology Department Includes a Rehabilitation center (opened in 2005) with 10 beds.
The Neurology Clinic is formed of a team of 19 neurologists (1 associate professor, 6 assistants professor and 13 MDs, most of them with PhD diploma and 5 PhD Fellows, 110 nurses, orderlies and physio-kinetotherapeuts. The neurologists from this clinic perform clinical activity – in the Department, Emergency Room and Ambulatory Care Unit, research activity and teaching Activity – more than 300 students from the Carol Davila University of Medicine and Pharmacy.

The main fields of interest for the neurologists in this department are cerebrovascular diseases and neurodegenerative diseases, but we also treat people with epilepsy, multiple sclerosis, peripheral nervous system diseases, muscular diseases and genetic diseases.

The Clinic is composed of 40 rooms with approximately 120 beds (more than 5000 people being admitted each ear) and laboratories: EEG, Video-EEG monitoring, Polysomnography, Cervico-cerebral vessels ultrasound, electrophysiology (electromyopgraphy). More than 4000 people are admitted each year for long duration hospitalization and approximately 25000 people for one day hospitalization.

The Neurology Research Unit has participated in contracts/grants and international multicentric studies:

  • 10 grants with internal financing
  • 25 international multicentric clinical trials
  • 8 European projects (one AAL project and one HORIZON 2020 involved monitoring people with cerebrovascular disease and neurocognitive impairment using sensors-based devices).
Role in the project

In this consortium, UHB represents one of the end-user organization, which will guarantee the involvement of primary end-users in all phases of the project. UHB as end-user will ensure that people with neurocognitive impairment and Parkinson’s disease will test the ProCare4Life system. UHB is assessing the needs and wishes of the users (people & caregivers) addressed by the project objectives and will give appropriate information to the users about the participation in this project. Moreover, UHB will send constant feedback to the technical partners after using the ProCare4Life project in order to improve the system.

Participants

Aging society
In 2018 there were 101.1 million persons aged 65 years or more living in the European Union at the start of 2018, representing almost one fifth (19.7 %) of the total population.
It is estimated that during the next three decades, the number of older people in the European Union will increase, reaching 149.2 million inhabitants by 2050 with a percentage of 28.5 % from total population. Romania is a middle-income Eastern European country with a population of approximately 19 million people, with 17.8% being over 65 years old.

People with Parkinson’s disease
Parkinson's disease (PD) is a progressive neurodegenerative disease that leads to disability, being the second most common neurodegenerative disease after Alzheimer’s disease. It affects 1-2 per 1000 of the population at any time. PD prevalence is increasing with age and PD affects 1% of the population above 60 years. It is estimated that in Romania, there are over 72,000 people with PD. During a five year period in the Neurology Department of the University Emergency Hospital there were admitted more than 500 people (557) with Parkinson’s disease with almost an equal distribution among gender (270 female people and 287 male people). Most of the admitted people are aged between 60-69 years-old (172 people) followed by 70-79 age group (149). People with advanced PD admitted in the Neurology Department may benefit from a large number of interventional therapeutic approaches like deep brain stimulation or continuous infusion of levodopa-carbidopa intestinal gel. All the people are also included in a neuro-rehabilitation program.

People with neurocognitive impairment
Nowadays, neurocognitive impairment has a high incidence and prevalence due to increased life expectancy secondary to intensification of primary and secondary prevention of cardio- and cerebrovascular diseases with high rates of mortality. It worth mentioning that aging is associated with an important increase in the incidence and prevalence of vascular and neurodegenerative neurocognitive impairment. Our department provides neurological, neuro-psychological and psychiatric expertise in the outpatient department with the possibility of issuing administrative documents for the support of people and their caregivers, recommendations for neuro-rehabilitation, periodic neurological and neuropsychological evaluations which offer the possibility of subsequent therapeutic reintervention. The medical staff has a strong link with the people' associations, offering information about their pathologies and also performing telemedicine with people' families.

Caregivers
Given the progressive nature of the neurodegenerative diseases, most of the people with such a disease require assistance of a caregiver even in the initial stages of the disease. The caregivers support these people with personal care and other activities of daily living. Providing care of these people may have impact on caregivers’ life, these individuals having a lower quality of life than general population. In Romania, most of the caregivers of the patient with neurodegenerative disease (Parkinson, dementia, etc) who still live at home are family members. Some of the people with a severe disability may receive a Disability Certificate from the Town City Hall and a formal caregiver. In progressed stages people may go to hospital for their care.

Health and care professionals
In Romania, family physicians are most of the times people’s first point of contact with the health system, providing care for individuals with neurocognitive impairment, Parkinson’s disease or other chronic diseases from early to end stages of the illness. Also, they are the healthcare professionals that could reduce the risk of developing certain diseases by primary prevention. The people are referred to the neurologist in order to establish the diagnosis and to receive the appropriate treatment. Also, the neurologists plan regular outpatient evaluations and eventually can schedule inpatient stays for the adjustment/ improvement of treatment and neurorehabilitation. Beside neurologists, also, a pivotal role is played by other professionals like physiotherapists, speech therapists or neuropsychologists and other specialists (cardiologists, etc).

Since COVID 19 pandemic, outpatient visits, scheduled admissions and neurorehabilitation treatment in our hospital which is an emergency hospital are limited, and remote resources as telemedicine are encouraged.

Results already achieved

WP2 - Task 2.4: Evaluation strategy and Pilot deployment roadmap intended to outline the evaluation strategy and pilot deployment roadmap, providing a guide for the pilots’ execution of the PROCare4Life project.

  • Task 2.2: online surveys: PD, AD, OD patients (27) + PD, AD, OD carers (23)
  • Understanding each person’s health limitations, living conditions, family structure, income, ability to use technology and the different cultural expectations regarding health care as this relates to the concept of integrated care that it’s shaped by the perspectives and expectations of various users in the health system.
  • WP6 - Pilot 1 – phase 1 (focused on feasibility of the technology, including installation procedures and enrollment phase)
  • Home implementation not yet started due to COVID-19 third wave restrictions

Next steps:

  • WP6 – Pilot 1 – phase 2 (focused on usability, as evaluated by the user groups, including user’s preferences of different components of the PROCare4Life solution). We will recruit 17 people; 3 professionals and 2 carers in rehabilitation and home care scenarios
  • WP6 – Pilot 2 (focused on evaluating the characteristics of the metrics generated by the Procare4life platform in real-life conditions). We will recruit 22 people, 3 professionals and 2 carers in rehabilitation and home scenarios.