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1.
J Med Internet Res ; 21(9): e14956, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31573914

RESUMO

BACKGROUND: Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. OBJECTIVE: The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. METHODS: A program analysis based on thick descriptions-including document examinations and semistructured interviews with relevant stakeholders-of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. RESULTS: Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. CONCLUSIONS: Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.

2.
BMC Health Serv Res ; 19(1): 370, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185997

RESUMO

BACKGROUND: Comprehensive 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) (7.5 M 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 (520 k 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 (216 k inhabitants). METHODS: The 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. DISCUSSION: The 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 REGISTRATION: NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).


Assuntos
Análise Custo-Benefício/normas , Prestação Integrada de Cuidados de Saúde/normas , Idoso , Protocolos Clínicos , Prestação Integrada de Cuidados de Saúde/economia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Estudos Observacionais como Assunto , Espanha
3.
BMC Health Serv Res ; 18(1): 576, 2018 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-30041653

RESUMO

BACKGROUND: Evaluation of integrated care programmes for individuals with multi-morbidity requires a broader evaluation framework and a broader definition of added value than is common in cost-utility analysis. This is possible through the use of Multi-Criteria Decision Analysis (MCDA). METHODS AND RESULTS: This paper presents the seven steps of an MCDA to evaluate 17 different integrated care programmes for individuals with multi-morbidity in 8 European countries participating in the 4-year, EU-funded SELFIE project. In step one, qualitative research was undertaken to better understand the decision-context of these programmes. The programmes faced decisions related to their sustainability in terms of reimbursement, continuation, extension, and/or wider implementation. In step two, a uniform set of decision criteria was defined in terms of outcomes measured across the 17 programmes: physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centeredness, continuity of care, and total health and social care costs. These were supplemented by programme-type specific outcomes. Step three presents the quasi-experimental studies designed to measure the performance of the programmes on the decision criteria. Step four gives details of the methods (Discrete Choice Experiment, Swing Weighting) to determine the relative importance of the decision criteria among five stakeholder groups per country. An example in step five illustrates the value-based method of MCDA by which the performance of the programmes on each decision criterion is combined with the weight of the respective criterion to derive an overall value score. Step six describes how we deal with uncertainty and introduces the Conditional Multi-Attribute Acceptability Curve. Step seven addresses the interpretation of results in stakeholder workshops. DISCUSSION: By discussing our solutions to the challenges involved in creating a uniform MCDA approach for the evaluation of different programmes, this paper provides guidance to future evaluations and stimulates debate on how to evaluate integrated care for multi-morbidity.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Múltiplas Afecções Crônicas/terapia , Análise Custo-Benefício , Tomada de Decisões , Técnicas de Apoio para a Decisão , Europa (Continente) , Medicina Baseada em Evidências , Humanos , Avaliação de Programas e Projetos de Saúde , Incerteza
5.
Arch. bronconeumol. (Ed. impr.) ; 52(1): e1-e3, ene. 2016. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-147919

RESUMO

La enfermedad relacionada con IgG4 es una condición fibroinflamatoria en la cual los distintos órganos afectados comparten similitudes patológicas. Recientemente se ha caracterizado clínica y radiológicamente esta enfermedad en órganos torácicos. La mayoría de los casos descritos abogan por un tratamiento precoz con terapia inmunosupresora y observan una respuesta rápida y favorable. Describimos 3 casos de enfermedad pulmonar relacionada con IgG4 que no recibieron tratamiento farmacológico y que tuvieron una respuesta clínica y radiológica favorable o estable durante el seguimiento. La terapia inmunosupresora puede no ser necesaria en algunos casos de enfermedad pulmonar relacionada con IgG4


IgG4-related disease is a fibroinflammatory disease in which the organs involved share similar pathological findings. Chest disease has been recently clinically and radiologically characterized. Most reports advocate prompt immunosuppressive therapy and describe a fast and good response. We report 3 cases of untreated IgG4-related lung disease that on follow-up have been clinically asymptomatic and radiologically stable or improved. In some cases of IgG4-related lung disease immunosuppressive therapy may not be warranted


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pneumopatias/diagnóstico , Imunoglobulina G , Imunossupressão/métodos , Imunossupressão , Reação em Cadeia da Polimerase/métodos , Espirometria/métodos , Tosse/complicações , Tosse/etiologia , Dispneia/complicações , Dacriocistite/diagnóstico , Dor no Peito/complicações , Dor no Peito/etiologia , Tórax
6.
Arch Bronconeumol ; 52(1): e1-3, 2016 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26456560

RESUMO

IgG4-related disease is a fibroinflammatory disease in which the organs involved share similar pathological findings. Chest disease has been recently clinically and radiologically characterized. Most reports advocate prompt immunosuppressive therapy and describe a fast and good response. We report 3 cases of untreated IgG4-related lung disease that on follow-up have been clinically asymptomatic and radiologically stable or improved. In some cases of IgG4-related lung disease immunosuppressive therapy may not be warranted.


Assuntos
Imunoglobulina G , Pneumopatias/imunologia , Adulto , Feminino , Humanos , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
7.
Arch Cardiol Mex ; 76(3): 263-8, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-17091797

RESUMO

OBJECTIVE: To estimate the prevalence of congenital heart defects in Colombia using the methodology of the Latin-American Collaborative Study of Congenital Malformations (ECLAMC, for its initials in Spanish) and to make an epidemiological description of the study population. MATERIAL AND METHODS: A prospective case-control study nested to a hospital-based cohort included 44,985 infants born from June 1, 2001 to April 30, 2005 in 11 Colombian hospitals. RESULTS: Fifty-five cases were reported (1.2 per 1,000); 36 (65.5%) corresponded to severe defects and 18 (32.7%) had associated extracardiac malformations. The following risk factors were identified: maternal age > or = 40 years, paternal age > or = 30 years, gestational age < or = 37 weeks, birth weight < or = 3,000 g and > or = 3 pregnancies. CONCLUSIONS: This study shows a similar prevalence of congenital heart disease to that found in Spain, Mexico, and South America. Risk factors identified emphasize the need for public health policies in a developing country undergoing an epidemiological transition.


Assuntos
Cardiopatias Congênitas/epidemiologia , Estudos de Casos e Controles , Colômbia/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Estudos Prospectivos
8.
Arch. cardiol. Méx ; 76(3): 263-268, jul.-sept. 2006.
Artigo em Espanhol | LILACS | ID: lil-568734

RESUMO

OBJECTIVE: To estimate the prevalence of congenital heart defects in Colombia using the methodology of the Latin-American Collaborative Study of Congenital Malformations (ECLAMC, for its initials in Spanish) and to make an epidemiological description of the study population. MATERIAL AND METHODS: A prospective case-control study nested to a hospital-based cohort included 44,985 infants born from June 1, 2001 to April 30, 2005 in 11 Colombian hospitals. RESULTS: Fifty-five cases were reported (1.2 per 1,000); 36 (65.5%) corresponded to severe defects and 18 (32.7%) had associated extracardiac malformations. The following risk factors were identified: maternal age > or = 40 years, paternal age > or = 30 years, gestational age < or = 37 weeks, birth weight < or = 3,000 g and > or = 3 pregnancies. CONCLUSIONS: This study shows a similar prevalence of congenital heart disease to that found in Spain, Mexico, and South America. Risk factors identified emphasize the need for public health policies in a developing country undergoing an epidemiological transition.


Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Cardiopatias Congênitas , Estudos de Casos e Controles , Colômbia , Prevalência , Estudos Prospectivos
9.
Colomb. med ; 36(4): 266-270, out. 2005.
Artigo em Espanhol | LILACS | ID: lil-422834

RESUMO

La displasia campomélica es una alteración del desarrollo óseo que se presenta de forma austosómica dominante. Se caracteriza por el encorvamiento de los fémures y tibias, junto con otras alteraciones orofaciales, cardiopulmonares y neurológicas. El cariotipo puede mostrar sexo reverso. Las mutaciones del gen SOX9 son responsables en la mayoría de casos de estas alteraciones esqueléticas y genitales. Se presenta aquí un caso de displasia campomélica con compromiso óseo de miembros inferiores característico, identificado a través de ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) en Colombia y se hace una revisión de la fisiopatología molecular de la enfermedad


Assuntos
Doenças do Desenvolvimento Ósseo , Anormalidades Congênitas , Genética Médica , Colômbia
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