Integrating computer-based health coaching into elder home care

Most health care takes place in the home, especially for people with chronic diseases and conditions of aging. Often the most effective components of the management of these conditions have to do with improving health behaviors, such as exercise, diet and adherence to agreed-upon treatments. With escalating health care costs, it is important to focus on technologies that facilitate home-based care with less expensive personnel, trained to provide coaching for improving health behaviors. The focus of this project is to develop a general-purpose architecture for providing computer-based health interventions for elders in their homes, facilitated by a professional health coach. This architecture incorporates knowledge representations to enable use of known principles of health behavior change. For example, we include modules to assess health behavior goals, motivations, barriers and readiness to change. In addition, based on our needs assessment of stakeholders (elders, family, caregivers, clinicians, service providers, researchers, government, and industry), we have focused on a design to facilitate the participation of family members and low-skilled caregivers as part of the care team. Sophisticated user models and authentication methods are required to determine the appropriate data access and user interface to the system for each user. We use current interoperability standards to anticipate and prepare for linkage with available electronic medical records and personal health records. The primary benefit of this approach is that multiple health behavior interventions can be made available using a common architecture and format that encourages a principled approach to the delivery of care to the home.