Syfte: Studiens syfte var att beskriva patienters upplevelser av betydelsen av fysioterapeutens insatser i det Mobila Sjukhusteamet (MST). Metod: Studien utfördes som en kvalitativ intervjustudie med sex patienter som varit inskrivna i MST på Skånes Universitetssjukhus i Malmö och under sin vårdtid, inneliggande på sjukhus och/eller i hemmet träffat fysioterapeuten i MST. Resultat: Studien resulterade i tre kategorier med åtta underkategorier. Trygghet med underkategorierna Tillgänglighet, Bli sedd och Bemötande vilket bland annat innefattar att kunna förstå sina förutsättningar och begränsningar. Möjliggörande med underkategorierna Kompetens och Delaktighet där upplevelsen var att aktivitet möjliggjordes genom bedömning av funktionsförmåga, hjälpmedelsordination och träningsprogram. Egenvärde med underkategorierna Självständighet, Fysisk kontext och Social kontext där vardagsaktiviteter och deltagarnas kontexter sågs som viktiga för känslan av självständighet. Slutsats: Studien visar att deltagarna upplevde de fysioterapeutiska insatserna som betydelsefulla då dessa möjliggjorde för deltagarna att fungera så självständigt som möjlig utifrån sina förutsättningar i sin naturliga kontext. Det framkom även att fysioterapeutens förmåga att med yrkesspecifik kompetens och personcentrerad vård var viktig för att få deltagarna delaktiga i sin vårdprocess. För deltagarna skapade detta trygghet och en ökad tro på sin egen förmåga. Det som värdesattes högt av deltagarna och upplevdes bidra till att främja återhämtningen var att få lov att vara i den miljö de trivdes allra bäst i –sitt hem. / Purpose: The purpose of the study was to describe patients´experiences of the importance of the physiotherapist´s interventions in the Mobile Hospital Team. Method: The study was conducted as a qualitative interview study with six patients who were enrolled in the Mobile Hospital Team at Skånes University Hospital in Malmö. The participants had during their period of care met the physiotherapist in the Mobile Hospital Team at the hospital and/or at home. Result: The study resulted in three categories with eight subcategories. Security with the subcategories Availability, Being seen and Reception which meant, among other things, being able to understand one´s condition and limitations. Enabling with the subcategories Competence and Participation where the experience was that activity was made possible through assessment of functional ability, prescription of assistive devices and training programs. Self-worth with the subcategories Independence, Physical context and Social context where everyday activities and the participants ‘contexts were seen as important factors for the feeling of independence. Conclusion: The study shows that the participants experienced the physiotherapeutic interventions as significant as these enabled the participants to function as independently as possible based on their conditions in their natural context. Furthermore the importance of the physiotherapist´s ability, with professional competence and patient centered care, was importing in making the participants feel involved in their situation, which created security and an increased belief in their own abilities. What was highly valued by the participants and felt contribute to promoting recovery was being allowed to be in the environment they were most comfortable in – their home.

Det finns ett uttalat behov av nya innovativa vårdmodeller inom hälso- och sjukvården. Svensk vård står inför signifikanta utmaningar och karaktäriseras av brist på sjukvårdsplatser, eskalerande kostnader och minskat patientförtroende. Hospital at Home (HaH) erbjuder möjligheter till förbättrad tillgänglighet, kostnadseffektivitet och patienttillit inom vården, men dess implementering begränsas av bristande förståelse för rådande finansiella förutsättningar, otillräckliga regelverk och inadekvata ersättningsmodeller. Denna studie syftar till att fördjupa förståelsen för de finansiella förutsättningar som påverkar implementeringen av innovativa vårdmodeller, såsom HaH, i komplexa decentraliserade sjukvårdssystem. Genom att utveckla ett teoretiskt ramverk som utforskar hur befintliga ersättningsstrukturer påverkar införandet av innovativa vårdformer, syftar denna studie till att bidra till förbättrat strategiskt beslutsfattande för en framgångsrik implementering och effektiv integrering av HaH i den svenska vården. Studien har tillämpat en utforskande abduktiv ansats, vilken realiserats genom en mixad metod som kombinerar enkäter och fallstudier. Datainsamlingen genomfördes via enkäter distribuerade till Sveriges 21 regioner samt genom semi-strukturerade intervjuer med representanter från tre svenska HaH-initiativ. Studien konstaterar att förberedelse och implementering av vårdinnovationer i decentraliserade system påverkas av flertalet både yttre och inre faktorer. Regelverk och direktiv, avtal samt extern budgetering och resursfördelning utgör grunden för hur vårdtjänster struktureras och finansieras. Dessa externa ramar är fundamentala i skapandet av en miljö som främjar vårdinnovation. Lokala variationer, vårdaktörer, verksamhetsformer och ersättningsmodeller spelar sedan en direkt roll i hur olika vårdmodeller utformas, finansieras och levereras i praktiken. Slutligen understryker studien behovet av en nationell definition av HaH och dess verksamhetsform, revidering av begränsande regelverk samt inkorporering av rörliga ersättningskomponenter till HaH-vårdutförare för att underlätta en storskalig implementering av HaH i Sverige. / There is a pressing need for innovative care delivery models within healthcare. Swedish healthcare faces formidable challenges including a shortage of hospital beds, escalating costs, and diminishing patient trust. Hospital at Home (HaH) presents an opportunity to enhance accessibility, cost-effectiveness, and patient trust within the healthcare system. However, its widespread adoption is impeded by a lack of understanding of current financial preconditions, insufficient regulations, and inadequate reimbursement models. This study seeks to enhance the understanding of financial preconditions influencing the implementation of innovative care models, such as HaH, within decentralized healthcare systems. Through the development of a theoretical framework that examines how current compensation structures impact the adoption of innovative care models, this study aims to inform strategic decision-making for the successful implementation and effective integration of HaH into Swedish healthcare. This thesis employs an exploratory abductive approach, utilizing a mixed-methods strategy that combines surveys and case studies. Data was collected through surveys distributed across all 21 Swedish regions, complemented by semi-structured interviews with representatives from three Swedish HaH initiatives. The study finds that the preparation and implementation of healthcare innovations in decentralized systems are significantly shaped by a range of external and internal factors. Regulatory frameworks, contractual agreements, and mechanisms for budgeting and resource distribution form the basis for how healthcare services are structured and financed. These external factors are fundamental in creating an environment that promotes healthcare innovation. Moreover, local variations, healthcare providers, operational forms, and reimbursement models directly influence how different care models are designed, financed, and delivered in practice. Finally, the study highlights the critical need for a national definition of HaH, the revision of restrictive regulations, and the integration of variable reimbursement components to facilitate widespread adoption of HaH across Sweden.

Η αντιμετώπιση των χρόνιων ασθενών αποτελεί σήμερα για τα συστήματα υγείας και κοινωνικής φροντίδας ένα από τα πιο δύσκολα προβλήματα διεθνώς, τόσο από ιατρικής όσο και από κοινωνικό-οικονομικής πλευράς. Για το λόγο αυτό, τα αντίστοιχα συστήματα στις ΗΠΑ και ΕΕ έχουν αποδυθεί τα τελευταία χρόνια σε ένα εντατικό αγώνα για την αναδόμηση (reengineering) της συνολικής αντιμετώπισής τους, με στόχο τη βελτιστοποίηση των παρεχομένων υπηρεσιών και τον εξορθολογισμό του κόστους. Στρατηγικό εργαλείο για τη παροχή των νέων υπηρεσιών αποτελούν οι νέες Τεχνολογίες Πληροφορικής και Επικοινωνιών (ΤΠΕ). Στο πλαίσιο της παρούσας ερευνητικής εργασίας εξετάζεται η αξιοποίηση σύγχρονων και ευρέως διαθέσιμων τεχνολογιών επικοινωνιών (ευρυζωνικότητα, δίκτυα κινητής τηλεφωνίας κ.ά.), σε συνδυασμό με τη χρήση καινοτόμων προϊόντων, όπως αυτά των «ηλεκτρονικών» υφασμάτων (e-Textiles) για την παροχή καινοτόμων υπηρεσιών παρακολούθησης από απόσταση. Η παρούσα διπλωματική είχε σαν στόχο την εφαρμογή και αξιολόγηση ενός προγράμματος πρώιμης εξόδου από νοσοκομείο και κατ’ οίκον νοσηλείας σε χρόνιους αναπνευστικούς ασθενείς στο Νοσοκομείο «Η Σωτηρία» και διεξήχθη στο πλαίσιο του Ευρωπαϊκού Ερευνητικού Προγράμματος ‘HealthWear’. Η μεθοδολογική προσέγγιση έγινε αφενός με την ευρεία βιβλιογραφική ανασκόπηση αναλόγων παρεμβάσεων και αφετέρου με την αξιολόγηση ενός προγράμματος κλινικής εφαρμογής του σε πραγματικές συνθήκες. Στο πρόγραμμα συμμετείχαν 48 ασθενείς με Χρόνια Αποφρακτική Πνευμονοπάθεια, διαχωρισμένοι τυχαία σε ομάδα ελέγχου (ενδονοσοκομειακή φροντίδα), και ομάδα παρέμβασης (πρώιμη έξοδος και παρακολούθηση με τη χρήση φορετών και φορητών, μη επεμβατικών συσκευών). Παρουσιάζονται αναλυτικά ο σχεδιασμός του συστήματος και της υπηρεσίας, η μεθοδολογία και ο τρόπος παρακολούθησης των ασθενών της ομάδας παρέμβασης καθώς και τα αποτελέσματα της αξιολόγησης. Η εφαρμογή του προγράμματος στην καθ’ ημέρα κλινική πράξη κατέδειξε τη χρήση φορητών και φορετών συστημάτων ως αξιόπιστη εναλλακτική μέθοδο για την πρώιμη έξοδο και συνέχεια της φροντίδας των ασθενών με Χ.Α.Π. Παράλληλα διερευνήθηκαν μελλοντικές προοπτικές εφαρμογών για την εξ αποστάσεως παρακολούθηση κατά τη διάρκεια του ύπνου ή ταυτόχρονα με εκτέλεση άσκησης σε εξωτερικούς χώρους. / Treatment of chronic patients is currently one of the most difficult international issues that health and social care systems need to address, both medically and by socio-economic terms. For this reason, the corresponding systems in the U.S. and EU have engaged the last years a lot of effort, in an intense struggle, for the restructuring (reengineering) of the total care management process, in order to optimize service and streamline costs. Strategic tool for providing new services is Information and Communication Technologies (ICTs). In the current study, the usage of modern and widely available communication technologies (broadband internet, mobile telephony, etc.), combined with innovative products, such as the 'electronic' fabrics (e-Textiles), in order to provide advanced remote monitoring services, were thoroughly examined. This thesis aimed to implement and evaluate a program of early hospital discharge, followed by a home hospitalization program, in chronic respiratory patients of ‘Sotiria’ Hospital in the region of Attica - Greece, conducted within the framework of a European Research Project named 'HealthWear'. The methodological approach followed was first to establish an in-depth background for this type of interventions, through a broad, thorough systematic literature review, and secondly to evaluate a clinical trial, in the real everyday life of a public hospital. The program involved 48 patients with Chronic Obstructive Pulmonary Disease (COPD), separated randomly into control group (traditional care) and intervention group (early discharge and follow up by using wearable, portable, non-invasive devices). A comprehensive presentation of the ICT system used, the clinical protocol of the service and the methodology for the remote monitoring the intervention group patients, are followed by the assessment results of the trial. Our experience from this trial allows the prediction that wearable and wireless systems can be proved as new era’s tools in patients’ remote follow up and personalized care, especially valuable in early discharge, as well as in home based monitoring during sleep and outdoor activities.