HSE Dublin and South East Press Release
Tuesday, 13 May 2025
The HSE’s SMILE 2 project, a pioneering initiative in partnership with the Enhanced Community Care (ECC) programme, Chronic Disease Community Specialist Teams (CD CST), and Caredoc, has successfully completed its final evaluation, showcasing advancements in managing multimorbid chronic diseases through integrated virtual case management and remote monitoring across HSE Dublin and South East in the counties of Carlow, Kilkenny, South Tipperary, Waterford and Wexford.
Key impacts from the final evaluation include:
- 600 patients with multi-morbidity received care and were empowered to self-manage their chronic disease conditions through remote monitoring
- The SMILE 2 project has significantly reduced healthcare utilisation, with a 55% reduction in emergency department visits and a 75% reduction in hospital bed nights for patients enrolled in SMILE for a 6 month period
- Patients reported improved health and wellbeing, with 94% acknowledging the positive impact.
- Integration with the ECC Programme provides continuity of care for patients by ensuring specialist care is available to patients when required
- The SMILE 2 Project has developed scalable processes and guidelines, providing a blueprint for a national case management service that optimizes nursing resources
Speaking about the impact of SMILE 2, Martina Queally, Regional Executive Officer (REO), HSE Dublin and South East, states: “I am thrilled to see the impact of the SMILE 2 project on patient health and wellbeing across HSE Dublin and South East in the counties of Carlow, Kilkenny, Tipperary South, Waterford Wexford. By empowering patients through innovative self-management tools and integrated care, we are not only enhancing their quality of life but also achieving a remarkable reduction in the demand on hospital services. With a 55% decrease in emergency department visits and a 75% reduction in hospital bed nights, SMILE 2 demonstrates the transformative potential of collaborative, patient-centred care and sets a new standard for chronic disease management. SMILE 2 represents a sustainable and replicable model for efficient healthcare delivery.”
Service user, Paul Wallace from Kilkenny explains the peace of mind patient users get from using SMILE: “The SMLE Programme has changed the way I manage my health condition, in that it has given me a regime in that I need to check the vitals, blood oxygen, heart rate, blood pressure, exercise and weight… I know something will be found before I know it’s a problem. So it takes away some of that stress.”
Transforming Healthcare:
Serving a population of 500,000 across Wexford, Waterford, Carlow, Kilkenny and South Tipperary, SMILE 2 has demonstrated a transformative approach to healthcare delivery that promises national scalability. Through remote monitoring, participants are supported to self-manage their conditions with specialist support available from the community teams when required. Participants use connected devices to monitor vital signs and wellbeing, with data transferred to an app on their tablets. The SMILE nursing team monitors this data in real-time, allowing for timely interventions. Specialist input is provided as required through the ECC Programme’s Chronic Disease CSTs. The integration with chronic disease CSTs facilitates holistic and coordinated care for patients, reducing unscheduled ED visits.
Patient Outcomes:
Through the SMILE 2 Project, 600 patients with multi-morbidity received treatment. The project provides treatment for people with 2 or more chronic diseases and covers eight chronic diseases, including the most prevalent (CVD, Diabetes Type 2, COPD and Asthma).
Patient impacts of the SMLE 2 project include:
- 55% reduction in emergency department visits
- 75% reduction in hospital bed nights
- 81% reduced in the number of General Practice (GP) visits for participating patients over a six-month period
This reduction in healthcare utilisation underscores the effectiveness of the project in preventing health exacerbations and managing chronic conditions within the community.
Improvements in Health and Well-being:
Patients have reported substantial improvements in health and well-being, with 94% acknowledging the program's positive impact. 72% of patients experienced stabilisation of their chronic disease symptoms, significantly exceeding the initial target of 30%.
Empowering People Through Self-Management:
Central to SMILE 2's success is patient empowerment, patients are trained and supported to monitor vital signs and wellbeing at home using connected devices. Real-time data is transferred to the ProACT app, allowing the SMILE nursing team to escalate deteriorations in health status to the CSTs as needed. This approach not only supports self-management but also ensures timely medical interventions, reducing the need for unscheduled emergency care.
Integration with Health Services:
Building on the success of SMILE 1, SMILE 2 seamlessly integrates with existing healthcare services through the ECC Programme, aspiring for national scalability. The collaborative efforts of Caredoc personnel, Integrated Care Consultants, GPs, CD CST staff, and hospital nurses have been pivotal in identifying and managing patients requiring intensive case management. The project has developed scalable processes and guidelines, providing a blueprint for a national case management service that maximizes the efficient use of nursing resources.
Video:
The SMILE (Supporting Multi-morbidity self-care through Integration, Learning, and eHealth) programme is transforming the way patients with chronic illnesses manage their health. This video features patient, Paul Wallace, Dr Anna Marie O’Brien, GP, Liz Murphy, Cardiovascular Nurse Specialist, and Niamh Ann Flanagan, SMILE Nurse as they share their experiences with the programme.
SMILE Programme: Supporting Patients with Chronic Illness Through Remote Monitoring (video)
Last updated on: 13 / 05 / 2025
