Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols

被引：31

作者：

Baltaxe, Erik ^{[1
,2
]}

Cano, Isaac ^{[1
,2
]}

Herranz, Carmen ^{[1
,3
]}

Barberan-Garcia, Anael ^{[1
,2
]}

Hernandez, Carme ^{[1
,2
]}

Alonso, Albert ^{[1
,2
]}

Jose Arguis, Maria ^{[1
,2
]}

Bescos, Cristina ^{[4
]}

Burgos, Felip ^{[1
,2
]}

Cleries, Montserrat ^{[5
]}

Carles Contel, Joan ^{[6
]}

de Batlle, Jordi ^{[2
,7
]}

Islam, Kamrul ^{[8
]}

Kaye, Rachelle ^{[9
]}

Lahr, Maarten ^{[10
]}

Martinez-Palli, Graciela ^{[1
,2
]}

Miralles, Felip ^{[11
]}

Moharra, Montserrat ^{[12
]}

Monterde, David ^{[13
]}

Piera, Jordi ^{[14
]}

Rios, Jose ^{[15
,16
,17
]}

Rodriguez, Nuria ^{[12
]}

Ron, Reut ^{[9
]}

Rutten-van Molken, Maureen ^{[18
,19
]}

Salas, Tomas ^{[12
]}

Santaeugenia, Sebastia ^{[6
,20
]}

Schonenberg, Helen ^{[4
]}

Solans, Oscar ^{[6
]}

Torres, Gerard ^{[2
,7
]}

Vargiu, Eloisa ^{[11
]}

Vela, Emili ^{[5
]}

Roca, Josep ^{[1
,2
]}

机构：

[1] Univ Barcelona, Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain

[2] Ctr Biomed Network Res Resp Dis CIBERES, Madrid, Spain

[3] CAPSBE, Barcelona, Spain

[4] Royal Philips Netherlands BV, Boblingen, Germany

[5] Serv Catala Salut, Area Atencio Sanitaria, Barcelona, Catalonia, Spain

[6] Generalitat Catalunya, Minist Hlth, Chron Care Program, Barcelona, Catalonia, Spain

[7] Inst Recerca Biomed IRBLeida, Resp Dept, Lleida, Spain

[8] Univ Bergen, Dept Econ, Bergen, Norway

[9] Assuta Med Ctr, Tel Aviv, Israel

[10] Univ Groningen, Univ Med Ctr Groningen, Dept Epidemiol, Groningen, Netherlands

[11] Eurecat Technol Ctr Catalonia, Barcelona, Catalunya, Spain

[12] Agencia Qualitat & Avaluacio Sanitaries Catalunya, Barcelona, Catalonia, Spain

[13] Inst Catala Salut, Serv Cent, Barcelona, Catalonia, Spain

[14] BSA, Badalona, Catalonia, Spain

[15] Inst Invest Biomed August Pi & Sunyer IDIBAPS, Med Stat Core Facil, Barcelona, Spain

[16] Hosp Clin Barcelona, Barcelona, Spain

[17] Univ Autonoma Barcelona, Fac Med, Biostat Unit, Barcelona, Spain

[18] Erasmus Univ, Sch Hlth Policy & Management, Rotterdam, Netherlands

[19] Erasmus Univ, Inst Med Technol Assessment, Rotterdam, Netherlands

[20] Univ Vic Cent Univ Catalonia, Cent Catalonia Chron Res Grp C3RG, Vic 08500, Spain

来源：

BMC HEALTH SERVICES RESEARCH | 2019年 / 19卷 / 1期

基金：

欧盟地平线“2020”;

关键词：

Chronic patients; Integrated care services; Multimorbidity; Service transferability; Home hospitalization; Prehabilitation; Digital tools; Implementation science; Risk assessment; Multi-criteria decision analysis; TRIPLE AIM; HEALTH; MORBIDITY; PROGRAMS; QUALITY;

D O I：

10.1186/s12913-019-4174-2

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

BackgroundComprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5M inhabitants).Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216k inhabitants).MethodsThe population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability.DiscussionThe current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection.Trials registrationNCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).

引用

页数：11

共 50 条

[1]

[Anonymous], COMRDI1510016 NEXTC

[2]

[Anonymous], 2015, INT RES PRAC HLTH SY

[3]

[Anonymous], 2017, BLOCKS TOOLS METH AS

[4]

Ardzeviite D, 2017, CEUR WORKSHOP P

[5] A Tutorial and Case Study in Propensity Score Analysis: An Application to Estimating the Effect of In-Hospital Smoking Cessation Counseling on Mortality [J].

Austin, Peter C. .

MULTIVARIATE BEHAVIORAL RESEARCH, 2011, 46 (01) :119-151

[6] Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries [J].

Barberan-Garcia, A. ;

Vogiatzis, I. ;

Solberg, H. S. ;

Vilaro, J. ;

Rodriguez, D. A. ;

Garasen, H. M. ;

Troosters, T. ;

Garcia-Aymerich, J. ;

Roca, J. .

RESPIRATORY MEDICINE, 2014, 108 (04) :628-637

[7] Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial [J].

Barberan-Garcia, Anael ;

Ubre, Marta ;

Roca, Josep ;

Lacy, Antonio M. ;

Burgos, Felip ;

Risco, Raquel ;

Momblan, Dulce ;

Balust, Jaume ;

Blanco, Isabel ;

Martinez-Palli, Graciela .

ANNALS OF SURGERY, 2018, 267 (01) :50-56

[8] The Triple Aim: Care, health, and cost [J].

Berwick, Donald M. ;

Nolan, Thomas W. ;

Whittington, John .

HEALTH AFFAIRS, 2008, 27 (03) :759-769

[9] Elaborating on theory with middle managers' experience implementing healthcare innovations in practice [J].

Birken, Sarah A. ;

DiMartino, Lisa D. ;

Kirk, Meredith A. ;

Lee, Shoou-Yih D. ;

McClelland, Mark ;

Albert, Nancy M. .

IMPLEMENTATION SCIENCE, 2016, 11

[10] From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider [J].

Bodenheimer, Thomas ;

Sinsky, Christine .

ANNALS OF FAMILY MEDICINE, 2014, 12 (06) :573-576

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