Integrated care services: lessons learned from the deployment of the NEXES project

Abstract

ObjectivesTo 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.SettingOne health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388).MethodThe 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.ResultsThe 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.ConclusionsThe 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.

Should we use gait speed in COPD, FEV1in frailty and dyspnoea in both?

“…Integrated care services in frail community-dwelling COPD patients improved clinical outcomes such as survival and decreased the emergency department visits, but it did not reduce hospital admissions [15].…”

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

“…En pacientes ingresados por agudización de EPOC, una actuación de cuidado integral basada en el desarrollo de un programa de tratamiento adaptado a las características propias de cada paciente y discutido entre el médico de primaria y el neumólogo, un taller de formación para el auto-cuidado de la enfermedad, la presencia de enfermeras de enlace entre primaria y hospital, y la posibilidad de que el paciente contactara con estas enfermeras especializadas a través de una aplicación informática consiguió reducir el número de reingresos en un 22%. Además, se consiguieron mejoras en el estado nutricional y en parámetros de auto-cuidado como el conocimiento de la enfermedad o el reconocimiento de los signos de agudización o la adherencia al tratamiento 38,[40][41][42] . En pacientes con IC que eran seguidos ambulatoriamente por una enfermera de enlace tras su ingreso también se consiguió una reducción significativa del 54 al 42% en el número de pacientes que reingresaban o fallecían, mejorando la calidad de vida y la satisfacción con la información recibida sobre la enfermedad 36 .…”

AIRWAYS-ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation

“…Unrecognised CRDs can be detected in frail elderly patients [33]. Optimising treatment and integrated care services of frail COPD patients with multimorbidities and polypharmacy improves certain health outcomes [34]. Plan since it aims to reduce the preventable and avoidable burden of morbidity, mortality and disability by means of multisectoral collaboration and cooperation at national, regional and global levels.…”