[Evaluation of the new integrated care approach in the Basque Country]. / Evaluación del nuevo enfoque en atención a la cronicidad en las organizaciones sanitarias integradas en el País Vasco.

BACKGROUND: In 2010 the Basque Government launched its "Strategy for tackling the challenge of chronicity in the Basque Country", in order to transform healthcare organisations into more integrated care models, with the aim of improving quality and efficiency in chronicity management. Four Integrated Healthcare Organisations (IHOs) were created to unify primary and specialised care into one single organisation. The aim of this study is to measure the degree of readiness of these IHOs to cope with chronicity, using the Chronic Care Model (CCM) as a reference. MATERIAL AND METHODS: Self-assessment processes using ARCHO (Assessment of Readiness for Chronicity in Health Care Organisations) were carried out in four IHOs by the management teams. RESULTS: The average score was 16 out of 100 points, which signals that healthcare organisations are undertaking action plans in the realm of integrated care, but with limited deployment and without a systematic process for evaluating outcomes. The dimension that ranks best is "Organization of the health system", while "Community health" has the lowest ranking. CONCLUSIONS: IHOs are the key for achieving integrated care for chronic illnesses. Integration of community resources and evaluation of results are two of the fields that need to be improved in order to achieve the set of interventions proposed in ARCHO. The organisational changes involved in the CCM require periods longer than two years.

Evaluación del nuevo enfoque en atención a la cronicidad en las organizaciones sanitarias integradas en el País Vasco / Evaluation of the new integrated care approach in the Basque Country

Fundamento: En el año 2010 Euskadi puso en marcha la "Estrategia para afrontar el reto de la cronicidad" tratando de reorientar las organizaciones sanitarias hacia modelos más integrados que proporcionaran una respuesta de calidad y más eficiente al paciente crónico. Se han creado cuatro Organizaciones Sanitarias Integradas (OSI) que suponen la integración en una única organización de los dos niveles asistenciales: atención primaria y especializada. El objetivo del estudio es conocer el grado de desarrollo alcanzado por las cuatro OSI en su estrategia de gestión integrada de la cronicidad tomando como referente de la evaluación el Chronic Care Model. Material y métodos: Autoevaluación en las cuatros OSI con la herramienta IEMAC por parte del equipo directivo de cada organización. Resultados: La puntuación promedio es de 16 puntos sobre 100, lo que implica que las organizaciones están emprendiendo planes de acción en el ámbito de la gestión de la atención integrada, pero con un despliegue limitado y sin que se puedan aportar evidencias de evaluación de los resultados de las acciones puestas en marcha. La dimensión mejor valorada fue "Organización del Sistema de Salud", mientras que la menos valorada fue "Salud Comunitaria". Conclusiones: Las OSI son motores del cambio para lograr una atención integral a la cronicidad. Los aspectos relacionados con la integración de recursos comunitarios y la evaluación de resultados constituyen dos de las áreas de mejora para desplegar el conjunto de intervenciones propuestas en IEMAC. Los cambios organizativos que supone el CCM requieren de períodos de tiempo superiores a dos años (AU)

Background: In 2010 the Basque Government launched its "Strategy for tackling the challenge of chronicity in the Basque Country", in order to transform healthcare organisations into more integrated care models, with the aim of improving quality and efficiency in chronicity management. Four Integrated Healthcare Organisations (IHOs) were created to unify primary and specialized care into one single organisation. The aim of this study is to measure the degree of readiness of these IHOs to cope with chronicity, using the Chronic Care Model (CCM) as a reference. Material and methods: Self-assessment processes using ARCHO (Assessment of Readiness for Chronicity in Health Care Organisations) were carried out in four IHOs by the management teams. Results: The average score was 16 out of 100 points, which signals that healthcare organisations are undertaking action plans in the realm of integrated care, but with limited deployment and without a systematic process for evaluating outcomes. The dimension that ranks best is "Organization of the health system", while "Community health" has the lowest ranking. Conclusions: IHOs are the key for achieving integrated care for chronic illnesses. Integration of community resources and evaluation of results are two of the fields that need to be improved in order to achieve the set of interventions proposed in ARCHO. The organizational changes involved in the CCM require periods longer than two years (AU)