Development of transferability guidance for integrated care models with special focus on Central and Eastern European countries

Abstract

Aim To develop pragmatic recommendations for Central and Eastern European (CEE) policymakers about transferability assessment of integrated care models established in higher income European Union (EU) countries. Methods Draft recommendations were developed based on Horizon 2020-funded SELFIE project deliverables related to 17 promising integrated care models for multimorbid patients throughout Europe, as well as on an online survey among CEE stakeholders on the relevance of implementation barriers. Draft recommendations were discussed at the SELFIE transferability workshop and finalized together with 22 experts from 12 CEE countries. Results Thirteen transferability recommendations are provided in three areas. Feasibility of local implementation covers the identification and prioritization of implementation barriers and proposals for potential solutions. Performance measurement of potentially transferable models focuses on the selection of models with proven benefits and assurance of performance monitoring. Transferability of financing methods for integrated care explores the relevance of financing methodologies and planning of adequate initial and long-term financing. Conclusions Implementation of international integrated care models cannot be recommended without evidence on its local feasibility or scientifically sound and locally relevant performance assessment in the country of origin. However, if the original financing method is not transferable to the target region, development of a locally relevant alternative financing method can be considered.

Barriers to Use Artificial Intelligence Methodologies in Health Technology Assessment in Central and East European Countries

“…The works of Basch (36) regarded the most impactful factors as being cultural, economic, social, institutional factors, as well as affordability, cost-effectiveness, and satisfying public demands. All other articles within this group are mostly concerned by the barriers in front the health technology assessment of new health technologies and their usage in the East European Countries jurisdiction (37)(38)(39)(40)(41)(42)(43)(44)(45). The barriers pointed out in the articles focused mainly on the methodological quality of documentation, differences in epidemiology and demographics, knowledge and differences in decision making criteria, differences in the organization of health care services delivery (46).…”

Guidebook on Best Practices in Public Health

“…There are thus many intermediary steps between policy that aims to achieve a specified outcome through selecting and funding interventions and the ultimate achievement of these outcomes, which require the concerted effort of many different people. Research on diffusion and implementation of innovations clearly shows that, even if new interventions prove effective and make intuitive sense, they are not implemented spontaneously or naturally (Brownson et al, 2015[99]; Jenkins, 2003 [96]). Indeed, implementation may be the greatest challenge in successfully transferring an intervention from one setting to another.…”

“…Planners are likely to encounter at least some of the following, common challenges when preparing implementation. Identify a "champion" within the political sphere to provide ongoing support Lack of understanding of intervention by implementers or lack of skill Document the core components of the intervention concisely and define the scope for adaptation Document the general skills implementers are required to have and align staffing plans Organise in-depth training for all implementers to gain intervention-specific knowledge and skills Allow implementers to visit sites that have already implemented the intervention previously, to understand characteristics of the intervention and the context of prior implementations Lack of capacity in organisations expected to implement the intervention Prepare detailed descriptions of resources needed and tasks to be performed to implement the intervention Compare resource needs to existing capacity and identify and fill gaps Build active support by senior leaders of implementing organisations so that staff perceive the implementation as conducive to their career rather than an additional burden or career risk Staffing shortages Adapt intervention to make better use of existing staff Hire additional staff Funding gaps Adapt intervention to make better use of existing structures and resources Reduce the scope of the intervention to make it feasible with existing funding constraints Engage stakeholders to gain further political support and raise additional funds Source: Based on Barnfield, Savolainen and Lounamaa (2020 [54]), "Health Promotion Interventions: Lessons from the Transfer of Good Practices in CHRODIS-PLUS", https://doi.org/10.3390/ijerph17041281; and Jenkins (2003 [96]), "Building a better health: A handbook of behavioural change", https://www.paho.org/hq/dmdocuments/2010/9275115907_reduce.pdf.…”

Improved survival of non-small cell lung cancer patients after introducing patient navigation: A retrospective cohort study with propensity score weighted historic control

“…OnkoNetwork was initiated in 2014, and from that time it has been thoroughly evaluated in the Horizon 2020 SELFIE project (www.selfie2020.eu). The SELFIE consortium developed a taxonomy of integrated care programs for persons with multi-morbidity [44]; provided evidence-based guidelines on financing/payment schemes with adequate incentives to implement integrated care [45,46]; conducted qualitative studies for the comprehensive description of 17 promising integrated care programs in 8 EU Member States, including OnkoNetwork [41,[47][48][49][50][51]; provided empirical evidence on the impact of integrated care for a wide range of outcomes using a Multi-Criteria Decision Analysis (MCDA) [52,53]; and developed implementation strategies tailored to different care settings and contexts in Europe, especially for Central and Eastern Europe [54]. Importantly, the SELFIE evaluation framework was designed to comply with any multi-morbidity integrated care initiative, and the MCDA evaluation criteria were formulated in generic terms to allow for the performance assessment of very different programs.…”