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Baltaxe E, Cano I, Herranz C, Barberan-Garcia A, Hernandez C, Alonso A, Arguis MJ, Bescos C, Burgos F, Cleries M, Contel JC, de Batlle J, Islam K, Kaye R, Lahr M, Martinez-Palli G, Miralles F, Moharra M, Monterde D, Piera J, Ríos J, Rodriguez N, Ron R, Rutten-van Mölken M, Salas T, Santaeugenia S, Schonenberg H, Solans O, Torres G, Vargiu E, Vela E, Roca J. Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols. BMC Health Serv Res 2019; 19:370. [PMID: 31185997 PMCID: PMC6560864 DOI: 10.1186/s12913-019-4174-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022] Open
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).
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Affiliation(s)
- Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. .,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carmen Herranz
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,CAPSBE. Consorci d'Atenció Primaria de Salut. Barcelona Esquerra, Barcelona, Spain
| | - Anael Barberan-Garcia
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carme Hernandez
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Albert Alonso
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - María José Arguis
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Bescos
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Felip Burgos
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Montserrat Cleries
- Area d'Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Joan Carles Contel
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Jordi de Batlle
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
| | | | - Maarten Lahr
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Graciela Martinez-Palli
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Felip Miralles
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Montserrat Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - David Monterde
- Institut Català de la Salut, Serveis Centrals, Barcelona, Catalonia, Spain
| | - Jordi Piera
- Badalona Serveis Assistencials (BSA), Badalona, Catalonia, Spain
| | - José Ríos
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Rodriguez
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Reut Ron
- Assuta Medical Centers, Tel Aviv-Yafo, Israel
| | - Maureen Rutten-van Mölken
- School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tomas Salas
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Sebastià Santaeugenia
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia, 08500, Vic, Spain
| | - Helen Schonenberg
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Oscar Solans
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Gerard Torres
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Eloisa Vargiu
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Emili Vela
- Area d'Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. .,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.
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