The results show that high resistin levels are associated with arthritis independently of MetS, whereas leptin is increased only in arthritis patients with MetS.

PurposeThis article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project.Design/methodology/approachThe project employs a service engineering and design science approach with the objective of addressing chronic and multimorbid patients in specialized multiprovider environments. It does this by applying information and communication technologies and organizational design. The project has been a cocreative effort with ongoing interviews and workshops with various stakeholders to inform the conceptualization of a solution, an intermediary step before the implementation phase.FindingsPatient journey disruptions occur when caregivers do not know what to do in specific situations. A potential solution is a virtual care operator (VCO) with a personalized patient card that would enable service ecosystem actors to integrate and coordinate their tasks. This article presents the basic design principles of such a solution.Research limitations/implicationsConceptual ideas and preliminary results only indicative.Practical implicationsSystemic integration efforts like those ongoing in Finland can benefit from the VCO concept encouraging a more collaborative way of thinking about integrative solutions and opening up new avenues of research on business implications and ecosystem strategies.Social implicationsThe VCO concept answers to the continuity of care, the rising costs of health care and the growing numbers of patients with chronic disease and multimorbidity whose care remains fragmented and uncoordinated.Originality/valueTaking an ecosystem approach to care integration and addressing interoperability issues are on the cutting edge of healthcare system transformation.

Background People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED. Aims We aim to assess the performance of acute care services provided to people living in nursing homes or long‐term homecare, focusing on ED transfer prevention, safety, cost‐effectiveness and experiences. Materials & Methods This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Studies were eligible for inclusion if they were peer‐reviewed and examined acute outreach services dedicated to delivering care to people in nursing homes or long‐term homecare. The service models could also have preventive components. The databases searched were Scopus and CINAHL. In addition, Robins‐I and SIGN checklists were used. The primary outcomes of prevented ED transfers or hospitalisations and the composite outcome of adverse events (mortality/Emergency Medical Service or ED visit after outreach service contact related to the same clinical condition) were graded with GRADE. Results Fifteen relevant original studies were found—all were observational and focused on nursing homes. The certainty of evidence for acute outreach services with preventive components to prevent ED transfers or hospitalisations was low. Stakeholders were satisfied with these services. The certainty of evidence for solely acute outreach services to prevent ED transfers or hospitalisations was very low and inconclusive. Reporting of adverse events was inconsistent, certainty of evidence for adverse events was low. Conclusion Published data might support adopting acute outreach services with preventive components for people living in nursing homes to reduce ED transfers, hospitalisations and possibly costs. If an outreach service is started, it is recommended that a cluster‐randomised or quasi‐experimental research design be incorporated to assess the effectiveness and safety of the service. More evidence is also needed on cost‐effectiveness and stakeholders' satisfaction. Systematic review registration number: PROSPERO CRD42020211048, date of registration: 25.09.2020.