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1.
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.
BMJ Open ; 6(4): e010301, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27084274

RESUMO

OBJECTIVES: Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. SETTINGS: The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). PARTICIPANTS: Responsible teams for regional data management in the five ACT regions. PRIMARY AND SECONDARY OUTCOME MEASURES: We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. RESULTS: There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. CONCLUSIONS: The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require prospective evaluation.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Vigilância da População/métodos , Medição de Risco/métodos , Europa (Continente) , Indicadores Básicos de Saúde , Humanos , Estudos Prospectivos
4.
Int J Integr Care ; 15: e006, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26034465

RESUMO

OBJECTIVES: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. SETTING: One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388). METHOD: The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. RESULTS: The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites. CONCLUSIONS: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

5.
Gac Sanit ; 22(1): 20-8, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-18261438

RESUMO

OBJECTIVES: To identify the most important health technologies (HT) introduced in the last 25 years and their impact on patients' health according to hospital internists and generalist physicians. METHODS: We performed a cross-sectional descriptive study. The 30 HT receiving the highest number of bibliometric citations in the previous 25 years (1977-2002) in generalist and primary care journals were selected. To assess the health impact of HT, a postal survey of the medical heads of 46 hospitals with 100-400 beds and an equal random sample of the directors of primary care centers was carried out in Catalonia, Spain. The professionals surveyed were asked to consider how adverse the effect on their patients' health would be if each of the HT on the list were unavailable. The personal and professional characteristics of the participating physicians were also collected. RESULTS: A total of 49 physicians answered the survey (53%). Instrumental and diagnostic technologies were considered to have the greatest impact on health, diagnostic imaging being the most highly scored. The lowest impact would be caused if some drugs were not available, hypoglycemic agents receiving the lowest scores. Although assessments were similar regardless of professional/practice characteristics (r > or = 0.7), some differences in diagnostic HT were observed, as well as variability in the participants' responses. CONCLUSIONS: Assessment of the impact of HT from the physicians' point of view varied. However, diagnostic and instrumental-visual technologies seem to be more highly rated than pharmacological innovations. Variability in responses was more closely related to the physicians' personal characteristics than to practice setting.


Assuntos
Atitude do Pessoal de Saúde , Medicina de Família e Comunidade , Medicina Interna , Ciência de Laboratório Médico , Adulto , Estudos Transversais , Coleta de Dados , Humanos , Pessoa de Meia-Idade , Espanha
6.
Gac. sanit. (Barc., Ed. impr.) ; 22(1): 20-28, ene.-feb. 2008. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-63365

RESUMO

Objetivos: Identificar las innovaciones médicas más relevantes de los últimos 25 años y conocer su impacto sobre la salud de los pacientes según la opinión de los médicos generalistas. Métodos: Estudio descriptivo transversal. Se seleccionaron las 30 tecnologías que habían recibido más citas bibliométricas en los últimos 25 años (1977-2002) en revistas médicas generalistas y de atención primaria. Para la evaluación de su impacto se encuestó por correo a los responsables médicos de 46 hospitales (entre 100 y 400 camas) y a una muestra aleatoria igual de directores de centros de atención primaria de Cataluña. Se pidió que valoraran las tecnologías cuya ausencia comportaría los mayores o menores efectos negativos sobre la salud de los pacientes. Se recogieron características profesionales y de los centros de los participantes. Resultados: Se obtuvo respuesta de 49 médicos (53%). Las tecnologías diagnósticas y las instrumentales han tenido un mayor impacto sobre la salud, y la ecografía fue la mejor valorada. En el otro extremo, se consideran diversos tratamientos farmacológicos, y los hipoglucemiantes orales fueron los menos valorados. Las valoraciones no fueron muy distintas según las características de los encuestados (r ≥ 0,7), aunque aparecieron algunas diferencias en las tecnologías diagnósticas y se observó cierta variabilidad en las respuestas. Conclusiones: La valoración del impacto de 30 tecnologías por médicos generalistas es variable, pero parece que las tecnologías diagnósticas e instrumentales a través de la imagen se valoran mejor que las farmacológicas. Esta variabilidad parece más relacionada con características individuales de los profesionales que con diferencias en sus ámbitos de práctica


Objectives: To identify the most important health technologies (HT) introduced in the last 25 years and their impact on patients' health according to hospital internists and generalist physicians. Methods: We performed a cross-sectional descriptive study. The 30 HT receiving the highest number of bibliometric citations in the previous 25 years (1977-2002) in generalist and primary care journals were selected. To assess the health impact of HT, a postal survey of the medical heads of 46 hospitals with 100-400 beds and an equal random sample of the directors of primary care centers was carried out in Catalonia, Spain. The professionals surveyed were asked to consider how adverse the effect on their patients' health would be if each of the HT on the list were unavailable. The personal and professional characteristics of the participating physicians were also collected. Results: A total of 49 physicians answered the survey (53%). Instrumental and diagnostic technologies were considered to have the greatest impact on health, diagnostic imaging being the most highly scored. The lowest impact would be caused if some drugs were not available, hypoglycemic agents receiving the lowest scores. Although assessments were similar regardless of professional/practice characteristics (r ≥ 0.7), some differences in diagnostic HT were observed, as well as variability in the participants' responses. Conclusions: Assessment of the impact of HT from the physicians' point of view varied. However, diagnostic and instrumental-visual technologies seem to be more highly rated than pharmacological innovations. Variability in responses was more closely related to the physicians' personal characteristics than to practice setting


Assuntos
Humanos , Tecnologia Biomédica/estatística & dados numéricos , Desenvolvimento Tecnológico/tendências , Levantamentos Sanitários , Estudos Transversais , Avaliação da Tecnologia Biomédica/estatística & dados numéricos , Impactos na Saúde
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