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Bally ELS, van Grieken A, Ye L, Ferrando M, Fernández-Salido M, Dix R, Zanutto O, Gallucci M, Vasiljev V, Carroll A, Darley A, Gil-Salmerón A, Ortet S, Rentoumis T, Kavoulis N, Mayora-Ibarra O, Karanasiou N, Koutalieris G, Hazelzet JA, Roozenbeek B, Dippel DWJ, Raat H. 'Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies' (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial. BMC Geriatr 2022; 22:680. [PMID: 35978306 PMCID: PMC9386998 DOI: 10.1186/s12877-022-03333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/01/2021] [Accepted: 07/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023. Methods A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data. Discussion This study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings. Trial registration ISRCTN registry number is 25089186. Date of trial registration is 16/11/2021.
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Affiliation(s)
- E L S Bally
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L Ye
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Ferrando
- R&D+I Consultancy, Kveloce I+D+i (Senior Europa SL), Valencia, Spain
| | - M Fernández-Salido
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - R Dix
- Fundación de La Comunidad Valenciana Para La Promoción Estratégica, El Desarrollo Y La Innovación Urbana (Las Naves), Valencia, Spain
| | - O Zanutto
- European Project Office Department, Istituto Per Servizi Di Ricovero E Assistenza Agli Anziani (Institute for Hospitalization and Care for the Elderly), Treviso, Italy
| | - M Gallucci
- Local Health Authority N.2 Treviso, Centre for Cognitive Disease and Dementia, Treviso, Italy
| | - V Vasiljev
- Faculty of Medicine, Department of Social Medcine and Epidemiology, University of Rijeka, Rijeka, Croatia
| | - A Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
| | - A Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - S Ortet
- Innovation Department, Cáritas Diocesana de Coimbra, Coimbra, Portugal
| | - T Rentoumis
- Alliance for Integrated Care, Athens, Greece
| | | | - O Mayora-Ibarra
- Center for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | | | | | - J A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Roozenbeek
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Abstract
PURPOSE A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment. DESIGN/METHODOLOGY/APPROACH Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes. FINDINGS The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of "successes", "challenges" and "lessons learnt". RESEARCH LIMITATIONS/IMPLICATIONS Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit. PRACTICAL IMPLICATIONS Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation. ORIGINALITY/VALUE Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.
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Affiliation(s)
- Thomas Round
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Ewan Ferlie
- King's Business School, King's College London, London, UK
| | - Charles Wolfe
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Franse CB, Voorham AJ, van Staveren R, Koppelaar E, Martijn R, Valía-Cotanda E, Alhambra-Borrás T, Rentoumis T, Bilajac L, Marchesi VV, Rukavina T, Verma A, Williams G, Clough G, Garcés-Ferrer J, Raso FM, Raat H. Evaluation design of Urban Health Centres Europe (UHCE): preventive integrated health and social care for community-dwelling older persons in five European cities. BMC Geriatr 2017; 17:209. [PMID: 28893178 PMCID: PMC5594491 DOI: 10.1186/s12877-017-0606-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 09/05/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation. METHODS In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants. DISCUSSION The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings. TRIAL REGISTRATION ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017.
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Affiliation(s)
- Carmen B. Franse
- Department of Public Health, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Antonius J.J. Voorham
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | | | - Elin Koppelaar
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | - Rens Martijn
- Rotterdam University of Applied Sciences, Research Centre Innovation in Care, Rotterdam, The Netherlands
| | | | | | | | - Lovorka Bilajac
- Department of Social Medicine and Epidemiology, Faculty of Medicine University of Rijeka, Rijeka, Croatia
- Teaching institute of Public Health Primorsko-goranska County, Branch Office Opatija, Rijeka, Croatia
| | - Vanja Vasiljev Marchesi
- Department of Social Medicine and Epidemiology, Faculty of Medicine University of Rijeka, Rijeka, Croatia
- Department of Public Health, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Tomislav Rukavina
- Department of Social Medicine and Epidemiology, Faculty of Medicine University of Rijeka, Rijeka, Croatia
- Teaching institute of Public Health Primorsko-goranska County, Branch Office Opatija, Rijeka, Croatia
| | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Greg Williams
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Gary Clough
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Francesco Mattace Raso
- Erasmus University Medical Center, Section of geriatric medicine, department of Internal Medicine, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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