Evaluación de la efectividad de un programa de atención integrada y proactiva a pacientes crónicos complejos

Coderch, Jordi; Pérez-Berruezo, Xavier; Sánchez-Pérez, Inma; Sánchez, Elvira; Ibern, Pere; Perez, M Jimenez; Carreras, Marc; Inoriza, José María

doi:10.1016/j.gaceta.2016.07.014

Cited by 18 publications

(11 citation statements)

References 14 publications

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“…In those patients that were prioritized by the risk stratification, the probability of contact with PC services considerably increased (OR = 2.01, CI: The literature shows that it is difficult to support the hypothesis that empowering PC reduces hospital use. 18,33,34 Similar to our study, the systematic review carried out by Smith et al 8 found five organizational studies that reported outcomes of health services utilization. [35][36][37][38][39] Among those, only two approaches 35,37 were comparable to our study.…”

Section: Discussionsupporting

confidence: 85%

“…In terms of effectiveness, evidence for multimorbid patients is scarce, and examples can hardly be compared, since the criteria and procedures for identification of these patients are diverse . The literature shows that it is difficult to support the hypothesis that empowering PC reduces hospital use . Similar to our study, the systematic review carried out by Smith et al found five organizational studies that reported outcomes of health services utilization .…”

Section: Discussionsupporting

confidence: 51%

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Impact of stratification on the effectiveness of a comprehensive patient‐centered strategy for multimorbid patients

Soto-Gordoa

Manuel

Fullaondo

et al. 2018

Health Services Research

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Objective The objective of this work was to assess the effectiveness of a population‐level patient‐centered intervention for multimorbid patients based on risk stratification for case finding in 2014 compared with the baseline scenario in 2012. Data Source Clinical and administrative databases. Study Design This was an observational cohort study with an intervention group and a historical control group. A propensity score by a genetic matching approach was used to minimize bias. Generalized linear models were used to analyze relationships among variables. Data Collection We included all eligible patients at the beginning of the year and followed them until death or until the follow‐up period concluded (end of the year). The control group (2012) totaled 3558 patients, and 4225 patients were in the intervention group (2014). Principal Finding A patient‐centered strategy based on risk stratification for case finding and the implementation of an integrated program based on new professional roles and an extensive infrastructure of information and communication technologies avoided 9 percent (OR: 0.91, CI: 0.86‐0.96) of hospitalizations. However, this effect was not found in nonprioritized groups whose probability of hospitalization increased (OR: 1.19, CI = 1.09‐1.30). Conclusions In a before‐and‐after analysis using propensity score matching, a comprehensive, patient‐centered, integrated care intervention was associated with a lower risk of hospital admission among prioritized patients, but not among patients who were not prioritized to receive the intervention.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 51%

Impact of stratification on the effectiveness of a comprehensive patient‐centered strategy for multimorbid patients

Soto-Gordoa

Manuel

Fullaondo

et al. 2018

Health Services Research

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“…Of the 37 articles, 14 (38%) describing multicomponent interventions to enhance primary care included technology-based enhancements as one of the innovation elements (Table 2) [22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Section: Technology-based Resultsmentioning

confidence: 99%

“…Additionally, four were from Europe (two from Germany and two from Spain) and one was from Argentina. Eight articles mentioned policies influencing the implementation of the innovation programs as broader country, regional, or organizational efforts to enhance primary care (Table 1) [22][23][24][25][26][27][28][29][30][31][32][33][34][35]. In terms of study designs and quality evaluation results, three publications reported controlled interventions (two of "fair" and one of "good" quality), six reported observational cohort or cross-sectional studies with controls (four of "fair" and two of "good" quality), one reported a case-control study of "fair" quality, and four reported pre-post studies without controls (one of "poor", one of "fair," and two of "good" quality).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…1. Enhancements leveraging electronic medical/health records [22,[24][25][26][27][28]34]: it was the most common category (reported in seven studies from five interventions) and was aimed at providers. Their use is related to identifying specific groups of patients (eg, chronically ill) or specific needs of patients (eg, services needed), exchanging patient information, and developing quality measurements/control and risk stratification.…”

Section: Updated It Systemsmentioning

confidence: 99%

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The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review (Preprint)

Jiménez¹,

Matchar²,

Koh³

et al. 2020

Preprint

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BACKGROUND Several countries around the world have implemented multicomponent interventions to enhance primary care (PC), as a way of strengthening their health systems to cope with an ageing, chronically ill population, and rising costs. Some of these efforts have included technology-based enhancements as one of their features to support the overall intervention, but their details and impact have not been explored. OBJECTIVE To identify the role of digital/health technologies within wider, multi-feature interventions aimed at enhancing PC, and to describe the type of technologies used, aim and stakeholder, and potential impacts. METHODS A systematic review was performed, following Cochrane guidelines. An electronic search, supplemented with manual and grey literature searches, was conducted to identify multicomponent interventions which included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive, narrative synthesis was used for analysis and presentation of results. RESULTS Fourteen out of 37 articles (38%) described the inclusion of a technology-based innovation, as part of their multicomponent interventions to enhance PC. The most common identified technologies were the use of electronic health records, data monitoring technologies and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased PC visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. CONCLUSIONS Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing PC, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving PC. Stronger policy and financial support is needed, as well as the advocacy of key stakeholders, to encourage the introduction of efficient technological innovations, backed by evidence-based research, so that digital technologies can fulfill the promise of supporting a strong, sustainable primary care.

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Cautela ante las reformas para “mejorar” la atención a la cronicidad

Badía

2019

Atención Primaria Práctica

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Evaluación de la efectividad de un programa de atención integrada y proactiva a pacientes crónicos complejos

Abstract: A high standard of quality, previous and during the study, and the inevitable contamination between groups, hindered the assessment of the marginal effectiveness of the program.

Cited by 18 publications

References 14 publications

Impact of stratification on the effectiveness of a comprehensive patient‐centered strategy for multimorbid patients

Impact of stratification on the effectiveness of a comprehensive patient‐centered strategy for multimorbid patients

The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review (Preprint)

Cautela ante las reformas para “mejorar” la atención a la cronicidad

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