Protocol for regional implementation of community-based collaborative management of complex chronic patients

Cano, Isaac; Dueñas-Espín, Iván; Hernández, Carme; Batlle, Jordi de; Benavent, Jaume; Contel, Juan Carlos; Baltaxe, Erik; Escarrabill, Joan; Fernández, Juan Manuel; Garcia‐Aymerich, Judith; Mas, Miquel Àngel; Miralles, Felip; Moharra, Montserrat; Piera-Jiménez, Jordi; Salas, Tomas; Santaeugènia, Sebastià; Soler, Néstor; Torres, Gerard; Vargiu, Eloisa; Vela, Emili; Roca, Josep

doi:10.1038/s41533-017-0043-9

Cited by 15 publications

(17 citation statements)

References 39 publications

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“… 6 7 These two factors strengthen the need for further evidence on cost-effectiveness of well-defined integrated care interventions for complex chronic patients. 27 …”

Section: Discussionmentioning

confidence: 99%

Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

Vela¹,

Tényi

Cano

et al. 2018

BMJ Open

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BackgroundClinical management of patients with chronic obstructive pulmonary disease (COPD) shows potential for improvement provided that patients’ heterogeneities are better understood. The study addresses the impact of comorbidities and its role in health risk assessment.ObjectiveTo explore the potential of health registry information to enhance clinical risk assessment and stratification.DesignFixed cohort study including all registered patients with COPD in Catalonia (Spain) (7.5 million citizens) at 31 December 2014 with 1-year (2015) follow-up.MethodsA total of 264 830 patients with COPD diagnosis, based on the International Classification of Diseases (Ninth Revision) coding, were assessed. Performance of multiple logistic regression models for the six main dependent variables of the study: mortality, hospitalisations (patients with one or more admissions; all cases and COPD-related), multiple hospitalisations (patients with at least two admissions; all causes and COPD-related) and users with high healthcare costs. Neither clinical nor forced spirometry data were available.ResultsMultimorbidity, assessed with the adjusted morbidity grouper, was the covariate with the highest impact in the predictive models, which in turn showed high performance measured by the C-statistics: (1) mortality (0.83), (2 and 3) hospitalisations (all causes: 0.77; COPD-related: 0.81), (4 and 5) multiple hospitalisations (all causes: 0.80; COPD-related: 0.87) and (6) users with high healthcare costs (0.76). Fifteen per cent of individuals with highest healthcare costs to year ratio represented 59% of the overall costs of patients with COPD.ConclusionsThe results stress the impact of assessing multimorbidity with the adjusted morbidity grouper on considered health indicators, which has implications for enhanced COPD staging and clinical management.Trial registration numberNCT02956395.

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“… 6 7 These two factors strengthen the need for further evidence on cost-effectiveness of well-defined integrated care interventions for complex chronic patients. 27 …”

Section: Discussionmentioning

confidence: 99%

Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

Vela¹,

Tényi

Cano

et al. 2018

BMJ Open

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“…Therefore, the answer on the perception of Social Services, Planned Care, and Hospital Care cannot be described from the population point of view. (2) 100 103 (28.5%) 125 (34.5%) 129 (35.6%) 5 (1.4%) Q3 (3) 100 244 (67.4%) 81 (22.4%) (9.4%) 3 (0.8%) Q4 (4) 100 102 (28.2%) 168 (46.4%) 82 (22.7%) 10 (2.8%) Q5 (5) 100 138 (38.1%) 132 (36.5%) 49 (13.5%) 43 (11.9%) Q6 (5) 100 (4) 90.9 206 (62.6%) 107 (32.5%) 14 (4.3%) 2 (0.6%) Q9 (7) 99.7 259 (71.7%) 78 (21.6%) 18 (5%) 6 (1.7%) Q10 (4) 99.7 238 (65.9%) 94 (26%) 27 (7.5%) 2 (0.6%) Q11 (8) 100 45 (12.4%) 261 (72.1%) 56 (15.5%) Q12 (9) 100 29 (8%) 129 (35.6%) 140 (38.7%) 64 (17.7%) Q13 (5) 100 179 (49.4%) 134 (37%) 33 (9.1%) 16 (4.4%) Q14 (10) 100 26 (7.2%) 113 (31.2%) 204 (56.4%) 19 (5.2%) Q15 (7) 100 185 (51.1%) 133 (36.7%) 30 (8.3%) 14 (3.9%) Q16 (4) 100 167 (46.1%) 155 (42.8%) 32 (8.8%) 8 (2.2%) Q17 (4) 100 186 (51.4%) 142 (39.2%) 31 (8.6%) 3 (0.8%) Q18 (11) 100 253 (69.9%) 64 (17.7%) 21 (5.8%) 9 (2.5%) 14 (3.9%) 1 (0.3%) Q19 (12) 99.7 141 (39.1%) 117 (32.4%) 42 (11.6%) 29 (8%) 32 (8.9%) Q20 (5) 100 103 (28.5%) 133 (36.7%) 85 (23.5%) 41 (11.3%) D3. Social Services Q21 (13) 100 118 (32.6%) 244 (67.4%) Q22 (14) 32.6 58 (49.2%) 6 (5.1%) 46 (39%) 8 (6.8%) Q23 (15) 32.6 60 (50.8%) 28 (23.7%) 21 (17.8%) 1 (0.8%) 8 (6.8%) D4.…”

Section: Descriptive Analysismentioning

confidence: 99%

“…The United Kingdom, with extensive experience working towards integration of care, has also developed and evaluated different potential plans to improve chronic care [7,8]. Spain has done so, with numerous actions undertaken and a variety of state-wide and regional strategies targeting different chronic conditions [9,10]. However, the impact of these strategies has hardly been evaluated, with some exceptions, such as the strategy deployed in the Basque Country [11] or the regional implementation carried out in Spain, Norway, and Greece in the context of the NEXES project (Integrated Care Services supported by Information Technologies for chronic patients with obstructive pulmonary disease, cardiac failure, and/or type II diabetes mellitus [12]).…”

Section: Introductionmentioning

confidence: 99%

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Spanish Validation of the “User Reported Measure of Care Coordination” Questionnaire for Older People with Complex, Chronic Conditions

Risco

Saüch

Albero

et al. 2020

IJERPH

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Introduction: Older people with complex, chronic conditions often receive insufficient or inefficient care provision, and few instruments are able to measure their perception of care provision. The “User Reported Measure of Care Coordination” instrument has been satisfactorily used to evaluate chronic care provision and integration. The aim of this study is to validate this instrument in Spanish. Methods: The questionnaire was adapted and validated in two phases: translation and cultural adaptation of the questionnaire and psychometric property measurement. Study population were chronic care conditions patients. Results: A total of 332 participants completed test re-test as part of the questionnaire validation process. The final version of the questionnaire had 6 domains: Health and Well-being (D1), Health day to day (D2), Social Services (D3), Planned Care (D4), Urgent Care (D5), and Hospital Care (D6). Cronbach’s alpha for the overall questionnaire was 0.86, indicating good internal consistency. When analyzing each domain, only Planned Care (D4) and Urgent Care (D5) had Cronbach’s Alphas slightly lower than 0.7, although this could be related to the low number of items in each domain. A good temporal stability was observed for the distinct subscales and items, with intraclass correlation coefficients varying from 0.412 to 0.929 (p < 0.05). Conclusion: The adapted version of the “User Reported Measure of Care Coordination” into Spanish proved to be a practical tool for use in our daily practice and an efficient instrument for assessment of care coordination in chronic, complex conditions in older people across services and levels of care.

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“…1) that articulates four comprehensive assessment protocols covering both vertical and horizontal levels of integration. One assessment protocol reports a population-based assessment of outcomes from past and current Catalan Health Plans, 2011–2015 [11] and 2016–2020 [12], respectively, whereas the other three assessment protocols address the deployment of specific IC services during the period 2017–2018, namely: i) Home hospitalization [13]; ii) Prehabilitation of candidates for major surgery [14]; and, iii) Community-based advanced care service for frail elderly [15, 16]. The ultimate aim of the research is to explore the application of innovative evaluation strategies [4] for IC services deployed in real-life settings.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols

Baltaxe

Cano

Herranz

et al. 2019

BMC Health Serv Res

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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). Electronic supplementa...

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Protocol for regional implementation of community-based collaborative management of complex chronic patients

Cited by 15 publications

References 39 publications

Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

Spanish Validation of the “User Reported Measure of Care Coordination” Questionnaire for Older People with Complex, Chronic Conditions

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols

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