Integrated care services: lessons learned from the deployment of the NEXES project
<p><strong>Objectives: </strong>To 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...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2015-03-01
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| Series: | International Journal of Integrated Care |
| Subjects: | |
| Online Access: | http://www.ijic.org/index.php/ijic/article/view/2018 |
| _version_ | 1829499010080047104 |
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| author | Carme Hernandez Albert Alonso Judith Garcia-Aymerich Anders Grimsmo Theodore Vontetsianos Francesc García Cuyàs Anna Garcia Altes Ioannis Vogiatzis Helge Garåsen Laura Pellise Leendert Wienhofen Isaac Cano Montserrat Meya Joan Ignasi Martinez Juan Escarrabill Josep Roca |
| author_facet | Carme Hernandez Albert Alonso Judith Garcia-Aymerich Anders Grimsmo Theodore Vontetsianos Francesc García Cuyàs Anna Garcia Altes Ioannis Vogiatzis Helge Garåsen Laura Pellise Leendert Wienhofen Isaac Cano Montserrat Meya Joan Ignasi Martinez Juan Escarrabill Josep Roca |
| author_sort | Carme Hernandez |
| collection | DOAJ |
| description | <p><strong>Objectives: </strong>To 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.</p><p><br /><strong>Setting: </strong>One health care sector in Spain (Barcelona) (<span class="italic">n</span> = 11.382); six municipalities in Norway (Trondheim) (<span class="italic">n</span> = 450); and one hospital in Greece (Athens) (<span class="italic">n</span> = 388).</p><p><br /><strong>Method: </strong>The four services were: (i) Home-based long-term maintenance of rehabilitation effects (<span class="italic">n</span> = 337); (ii) Enhanced Care for frail patients, <span class="italic">n</span> = 1340); (iii) Home Hospitalization and Early Discharge (<span class="italic">n</span> = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (<span class="italic">n</span> = 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.</p><p><br /><strong>Results: </strong>The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (<span class="italic">p</span> < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (<span class="italic">p</span> < 0.05); (iii) Reduced in-hospital days for all types of patients (<span class="italic">p</span> < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (<span class="italic">p</span> < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites.</p><p><br /><strong>Conclusions: </strong>The 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.</p> |
| first_indexed | 2024-12-16T08:24:07Z |
| format | Article |
| id | doaj.art-ee4f127b8d4f425bbe08a8ac05d21754 |
| institution | Directory Open Access Journal |
| issn | 1568-4156 |
| language | English |
| last_indexed | 2024-12-16T08:24:07Z |
| publishDate | 2015-03-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | International Journal of Integrated Care |
| spelling | doaj.art-ee4f127b8d4f425bbe08a8ac05d217542022-12-21T22:38:02ZengUbiquity PressInternational Journal of Integrated Care1568-41562015-03-011511735Integrated care services: lessons learned from the deployment of the NEXES projectCarme HernandezAlbert AlonsoJudith Garcia-AymerichAnders GrimsmoTheodore VontetsianosFrancesc García CuyàsAnna Garcia AltesIoannis VogiatzisHelge GaråsenLaura PelliseLeendert WienhofenIsaac CanoMontserrat MeyaJoan Ignasi MartinezJuan EscarrabillJosep Roca<p><strong>Objectives: </strong>To 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.</p><p><br /><strong>Setting: </strong>One health care sector in Spain (Barcelona) (<span class="italic">n</span> = 11.382); six municipalities in Norway (Trondheim) (<span class="italic">n</span> = 450); and one hospital in Greece (Athens) (<span class="italic">n</span> = 388).</p><p><br /><strong>Method: </strong>The four services were: (i) Home-based long-term maintenance of rehabilitation effects (<span class="italic">n</span> = 337); (ii) Enhanced Care for frail patients, <span class="italic">n</span> = 1340); (iii) Home Hospitalization and Early Discharge (<span class="italic">n</span> = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (<span class="italic">n</span> = 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.</p><p><br /><strong>Results: </strong>The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (<span class="italic">p</span> < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (<span class="italic">p</span> < 0.05); (iii) Reduced in-hospital days for all types of patients (<span class="italic">p</span> < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (<span class="italic">p</span> < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites.</p><p><br /><strong>Conclusions: </strong>The 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.</p>http://www.ijic.org/index.php/ijic/article/view/2018case managementintegrated health care systemschronic diseaselong-term caretelemedicine |
| spellingShingle | Carme Hernandez Albert Alonso Judith Garcia-Aymerich Anders Grimsmo Theodore Vontetsianos Francesc García Cuyàs Anna Garcia Altes Ioannis Vogiatzis Helge Garåsen Laura Pellise Leendert Wienhofen Isaac Cano Montserrat Meya Joan Ignasi Martinez Juan Escarrabill Josep Roca Integrated care services: lessons learned from the deployment of the NEXES project International Journal of Integrated Care case management integrated health care systems chronic disease long-term care telemedicine |
| title | Integrated care services: lessons learned from the deployment of the NEXES project |
| title_full | Integrated care services: lessons learned from the deployment of the NEXES project |
| title_fullStr | Integrated care services: lessons learned from the deployment of the NEXES project |
| title_full_unstemmed | Integrated care services: lessons learned from the deployment of the NEXES project |
| title_short | Integrated care services: lessons learned from the deployment of the NEXES project |
| title_sort | integrated care services lessons learned from the deployment of the nexes project |
| topic | case management integrated health care systems chronic disease long-term care telemedicine |
| url | http://www.ijic.org/index.php/ijic/article/view/2018 |
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