title: Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training - COGWEB Network.
abstract: BACKGROUND
  Cognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector.
  
  
  OBJECTIVE
  The objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB).
  
  
  METHODS
  The setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled.
  
  
  RESULTS
  The network included 68 professionals from 41 centers, (33/41) 80% clinical, (8/41) 19% nonclinical. A total of 298 patients received cognitive training; 45.3% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6%), (2) structural brain lesions (63/298, 21.1%), (3) autoimmune (40/298, 13.4%), (4) schizophrenia (30/298, 10.1%), and (5) others (50/298, 16.8%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education.
  
  
  CONCLUSIONS
  Over its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden.
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal ; Clinical Research Office Health Sciences Department University of Aveiro Aveiro Portugal.
authors.forename: Vítor
authors.identifier: 0000-0002-5333-4771
authors.initials: V
authors.lastname: Tedim Cruz
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neuropsychology Laboratory, Neurology Department Santa Maria da Feira Portugal.
authors.forename: Joana
authors.identifier: 0000-0002-6591-3578
authors.initials: J
authors.lastname: Pais
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal ; Public Health Institute - ISPUP University of Porto Porto Portugal.
authors.forename: Luis
authors.identifier: 0000-0002-0903-494X
authors.initials: L
authors.lastname: Ruano
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neuropsychology Laboratory, Neurology Department Santa Maria da Feira Portugal.
authors.forename: Cátia
authors.identifier: 0000-0003-2708-8826
authors.initials: C
authors.lastname: Mateus
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal.
authors.forename: Márcio
authors.identifier: 0000-0002-8332-8487
authors.initials: M
authors.lastname: Colunas
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal.
authors.forename: Ivânia
authors.identifier: 0000-0002-5622-4631
authors.initials: I
authors.lastname: Alves
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal.
authors.forename: Rui
authors.identifier: 0000-0002-7688-6448
authors.initials: R
authors.lastname: Barreto
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal.
authors.forename: Eduardo
authors.identifier: 0000-0003-3130-5846
authors.initials: E
authors.lastname: Conde
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neuropsychology Laboratory, Neurology Department Santa Maria da Feira Portugal.
authors.forename: Andreia
authors.identifier: 0000-0001-6500-3219
authors.initials: A
authors.lastname: Sousa
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal.
authors.forename: Isabel
authors.identifier: 0000-0003-1615-9342
authors.initials: I
authors.lastname: Araújo
authors.affiliation: Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga Neurology Department Santa Maria da Feira Portugal ; University Institute of Maia - ISMAI Maia Portugal.
authors.forename: Virgílio
authors.identifier: 0000-0001-6025-8511
authors.initials: V
authors.lastname: Bento
authors.affiliation: UnIGENe Instituto de Biologia Molecular e Celular University of Porto Porto Portugal.
authors.forename: Paula
authors.identifier: 0000-0002-3461-230X
authors.initials: P
authors.lastname: Coutinho
authors.affiliation: Clinical Research Office Health Sciences Department University of Aveiro Aveiro Portugal.
authors.forename: Nelson
authors.identifier: 0000-0003-3801-7249
authors.initials: N
authors.lastname: Rocha
keywords: cognitive training; collaborative network; dementia; eHealth systems; memory clinic; mental health services; neurorehabilitation; schizophrenia; stroke