About this document
This memoir is the founding document of the PREDICARE programme. It does not describe a project — it constructs the argument that such a project is both necessary and possible.
Its starting point is a counter-intuitive observation: medical abandonment — the phenomenon by which patients progressively exit the healthcare system before returning to it in emergency, at an aggravated stage and at a considerably higher cost — is not an individual failure. It is a structural property of the system. It is predictable, modelable, and in part preventable.
A system that regularly and predictably produces the same abandonment trajectories does not have a patient problem. It has an architectural problem.
From this diagnosis follows a concrete architectural proposal: PREDICARE, a territorial predictive medicine programme founded on individual medical digital twins. The memoir establishes its epidemiological, economic and organisational foundations, and documents its deployment architecture according to the RAISE Framework.
Contents
The document is structured in five parts, from the problem statement to the deployment plan.
Table of contents — Version 3
Medical abandonment as a systemic property
Epidemiology · Trajectories · Systemic costs · Modelling the phenomenon
Limits of existing approaches
Curative medicine · Conventional prevention · Current digital tools · Why they fail
Architecture of the solution — TweenMe & PREDICARE
Digital twins · TweenMe · Territorial infrastructure · GHT integration
Deployment according to the RAISE Framework
Regulation · Governance · Interoperability · Validation · Explainability
Deployment plan & funding model
Pilot phase · BPI France · Territorial funding · Scale perspectives
Excerpt
Extract from the introduction — Part I.
Medical abandonment is an observable, measurable phenomenon, yet one that remains largely under-theorised in the public health literature. The term denotes the process by which a patient, initially in regular contact with the healthcare system, progressively withdraws from it — through an accumulation of micro-ruptures, relinquishments, and logistical or financial obstacles — until returning only in an emergency, at an aggravated pathological stage.
What the literature treats predominantly as a problem of individual behaviour — adherence, compliance, therapeutic education — reveals, upon systemic analysis, an entirely different nature. Abandonment trajectories are not random. They obey reproducible patterns, correlated with identifiable structural determinants: territorial medical density, financial accessibility, the cognitive burden of care pathways, the administrative fragmentation of medical records.
A system that regularly and predictably produces the same abandonment trajectories is not encountering failing patients. It is exhibiting its own architectural failures. It is from this distinction — between individual property and systemic property — that the entirety of the analysis that follows departs, as does the response architecture that derives from it…
◎ Publication pending
The complete memoir — 110 pages — will be made available in coordination with associated external announcements. Publication date to be announced.
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◎ Forthcoming publication
PREDICARE Memoir v3 — 110 pages
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