Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Study protocol

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

Authors: Erik Baltaxe, Isaac Cano, Carmen Herranz, Anael Barberan-Garcia, Carme Hernandez, Albert Alonso, María José Arguis, Cristina Bescos, Felip Burgos, Montserrat Cleries, Joan Carles Contel, Jordi de Batlle, Kamrul Islam, Rachelle Kaye, Maarten Lahr, Graciela Martinez-Palli, Felip Miralles, Montserrat Moharra, David Monterde, Jordi Piera, José Ríos, Nuria Rodriguez, Reut Ron, Maureen Rutten-van Mölken, Tomas Salas, Sebastià Santaeugenia, Helen Schonenberg, Oscar Solans, Gerard Torres, Eloisa Vargiu, Emili Vela, Josep Roca

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

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).
Appendix
Available only for authorised users
Literature
1.
Spreeuwenberg C, Kodner DL. Integrated care: meaning, logic, appplications and implications - a discussion paper. Int J Integr Care. 2002;2:1–6.CrossRef
2.
Lewis R, Rosen R, Godwin N, Dixon J. Where next for integrated care organisations in the English NHS? London: The Nuffield Trust; 2010.
3.
Goodwin N, Alonso A. Understanding integrated care: the role of information and communication technology. In: Meyer I, Muller S, Kubitschke L, editors. Achieving effective integrated e-care beyond the silos. IGI Global; 2014. p. 63–88.CrossRef
4.
5.
Araujo de Carvalho I, Epping-Jordan J, Pot AM, Kelley E, Toro N, Thiyagarajan JA, et al. Organizing integrated health-care services to meet older people’s needs. Bull World Health Organ. 2017;95:756–63.CrossRef
6.
7.
Busse R, Stahl J. Integrated care experiences and outcomes in Germany, the Netherlands, and England. Health Aff. 2014;33:1549–58.CrossRef
8.
Cano I, Alonso A, Hernandez C, Burgos F, Barberan A, Roldan J, et al. An adaptive case management system to support integrated care services: lessons learned from the NEXES project. J Biomed Inform. 2015;55:11–22.CrossRef
9.
Hernandez C, Alonso A, Garcia-Aymerich J, Grimsmo A, Vontetsianos T, Cuyàs FG, et al. Integrated care services: lessons learned from the deployment of the NEXES project. Int J Integr Care. 2015;15:e006.PubMedPubMedCentral
10.
Dates M, Lennox-chhugani N, Sant H, Pereira A, Tedeschi M. Health system performance assessment – integrated care assessment ( 20157303 HSPA). European union; 2018.
11.
12.
13.
Hernandez C, Garcia-Aymerich J, Alonso A, Grimsmo A, Vontetsianos T, Garcia-Cuyas F, et al. Implementation of home hospitalization and early discharge as an integrated care service: a ten years pragmatic assessment. Int J Integr Care. 2018;18:1–11.
14.
Barberan-Garcia A, Ubré M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised Prehabilitation in high-risk patients undergoing elective major abdominal surgery : a randomized blinded controlled trial. Ann Surg. 2018;267:50–6.CrossRef
15.
Hernandez C, Aibar J, De Batlle J, Gomez-Cabrero D, Soler N, Duran-Tauleria E, et al. Assessment of health status and program performance in patients on long-term oxygen therapy. Respir Med. 2015;109:500–9.CrossRef
16.
Cano I, Dueñas-Espín I, Hernandez C, De Batlle J, Benavent J, Contel JC, et al. Protocol for regional implementation of community-based collaborative Management of Complex Chronic Patients. npj Prim Care Respir Med. 2017;27:44.CrossRef
17.
Bodenheimer T, Sinsky C. From triple to quadruple aim: Care of the Patient Requires Care of the provider. Ann Fam Med. 2014;12:573–6.CrossRef
18.
West CP. Physician well-being: expanding the triple aim. J Gen Intern Med. 2016;31:458–9.CrossRef
19.
Font D, Escarrabill J, Gómez M, Ruiz R, Enfedaque B, Altimiras X. Integrated health care Barcelona Esquerra (Ais-be): a global view of Organisational development, re-engineering of processes and improvement of the information systems. The role of the Tertiary University hospital in the transformation. Int J Integr Care. 2016;16:1–10.CrossRef
20.
Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–44.CrossRef
21.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20:64–78.CrossRef
22.
Hernandez C, Casas A, Escarrabill J, Alonso J, Puig-Junoy J, Farrero E, et al. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. Eur Respir J. 2003;21:58–67.CrossRef
23.
Casas A, Troosters T, Garcia-Aymerich J, Roca J, Hernandez C, Alonso A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28:123–30.CrossRef
24.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399–424.CrossRef
25.
Brookhart MA, Schneeweiss S, Rothman KJ, Glynn RJ, Avorn J, Stürmer T. Variable selection for propensity score models. Am J Epidemiol. 2006;163:1149–56.CrossRef
26.
Stiefel M, Nolan K. A guide to measuring the triple aim: population health, experience of care, and per capita cost. IHI innovation series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.
27.
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27:759–69.CrossRef
28.
Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, et al. Standards for reporting implementation studies (StaRI): explanation and elaboration document. BMJ Open. 2017;7:e013318.CrossRef
29.
Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. Br Med J. 2013;347:2–7.CrossRef
30.
Whittington JW, Nolan K, Lewis N, Torres T. Pursuing the triple aim: the first 7 years. Milbank Q. 2015;93:263–300.CrossRef
31.
Tsiachristas A, Cramm JM, Nieboer A, Rutten- van Mölken M. Broader economic evaluation of disease management programs using multi-criteria decision analysis. Int J Technol Assess Health Care. 2013;29:301–8.CrossRef
32.
Rutten-Van Mölken M, Leijten F, Hoedemakers M, Tsiachristas A, Verbeek N, Karimi M, et al. Strengthening the evidence-base of integrated care for people with multi-morbidity in Europe using multi-criteria decision analysis (MCDA). BMC Health Serv Res. 2018;18:576.CrossRef
33.
34.
35.
Warner G, Lawson B, Sampalli T, Burge F, Gibson R, Wood S. Applying the consolidated framework for implementation research to identify barriers affecting implementation of an online frailty tool into primary health care: a qualitative study. BMC Health Serv Res. 2018;18:395.CrossRef
36.
Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the consolidated framework for implementation research. Implement Sci. 2016;11:72.CrossRef
37.
Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf. 2014;23:290–8.CrossRef
38.
Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260:1743–8.CrossRef
39.
Dueñas-Espín I, Vela E, Pauws S, Bescos C, Cano I, Cleries M, et al. Proposals for enhanced health risk assessment and stratification in an integrated care scenario. BMJ Open. 2016;6:e010301.CrossRef
40.
Vela E, Tényi Á, Cano I, Monterde D, Cleries M, Garcia-Altes A, et al. Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management. BMJ Open. 2018;8:e017283.CrossRef
41.
42.
Monterde D, Vela E, Clèries M, grupo colaborativo GMA. Los grupos de morbilidad ajustados: nuevo agrupador de morbilidad poblacional de utilidad en el ámbito de la atención primaria. Atención Primaria. 2016;48:674–82.CrossRef
43.
Barberan-Garcia A, Vogiatzis I, Solberg HS, Vilaró J, Rodríguez DA, Garåsen HM, et al. Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries. Respir Med. 2014;108:628–37.CrossRef
44.
Modol JR. Navigating Towards Self-Care: The Catalan Public Patient Portal. In: Aanestad M, Grisot M, Hanseth O, Vassilakopoulou P, editors. Information infrastructures within European health care: working with the Installed Base. Cham: Springer International Publishing; 2017. p. 173–92.CrossRef
45.
46.
47.
Swenson K. Mastering the Unpredictable Vol. XXXIII, Uma ética para quantos? 2012. p. 81–7.
48.
Herrmann C, Kurz M. In: Schmidt W, editor. Adaptive case management: supporting knowledge intensive processes with IT systems BT - S-BPM ONE - learning by doing - doing by learning. Berlin, Heidelberg: Springer Berlin Heidelberg; 2011. p. 80–97.CrossRef
49.
Reichheld FF. The one number you need to grow. Harv Bus Rev. 2003;81:46–54.PubMed
50.
51.
Kidholm K, Ekeland AG, Jensen LK, Rasmussen J, Pedersen CD, Bowes A, et al. A model for assessment of telemedicine applications: mast. Int J Technol Assess Health Care. 2012;28:44–51.CrossRef
52.
Institute of Medicine. Integrating research and practice: health system leaders working toward high-value care: workshop summary. Alper J, Grossmann C, editors. Washington, DC: the National Academies Press; 2015.
53.
Gershon AS, Jafarzadeh SR, Wilson KC, Walkey AJ. Clinical knowledge from observational studies: everything you wanted to know but were afraid to ask. Am J Respir Crit Care Med. 2018;198:859–67.CrossRef
54.
Metadata
Title
Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols
Authors
Erik Baltaxe
Isaac Cano
Carmen Herranz
Anael Barberan-Garcia
Carme Hernandez
Albert Alonso
María José Arguis
Cristina Bescos
Felip Burgos
Montserrat Cleries
Joan Carles Contel
Jordi de Batlle
Kamrul Islam
Rachelle Kaye
Maarten Lahr
Graciela Martinez-Palli
Felip Miralles
Montserrat Moharra
David Monterde
Jordi Piera
José Ríos
Nuria Rodriguez
Reut Ron
Maureen Rutten-van Mölken
Tomas Salas
Sebastià Santaeugenia
Helen Schonenberg
Oscar Solans
Gerard Torres
Eloisa Vargiu
Emili Vela
Josep Roca
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4174-2

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Research article

Access to cardiac rehabilitation and the role of language barriers in the provision of cardiac rehabilitation to migrants

Research article

High admission rates and heavy inpatient service costs of urban tuberculosis patients in eastern China

Research article

Multiple chronic conditions and associated health care expenses in US adults with cancer: a 2010–2015 Medical Expenditure Panel Survey study

Research article

The effect of adapting Hospital at Home to facilitate implementation and sustainment on program drift or voltage drop

Research article

From restrictive to more liberal: variations in mortality among patients in opioid maintenance treatment over a 12-year period

Research article

Challenges in primary care for diabetes and hypertension: an observational study of the Kolar district in rural India