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Title: Integrated care services: lessons learned from the deployment of the NEXES project
Author: Hernández, Carmen
Alonso, Albert
Garcia Aymerich, Judith
Grimsmo, Anders
Vontetsianos, Theodore
García Cuyàs, Francesc
Garcia Altes, Anna
Vogiatzis, Ioannis
Garåsen, Helge
Pellise, Laura
Wienhofen, Leendert
Cano Franco, Isaac
Meya, Montserrat
Moharra, Montserrat
Martinez, Joan Ignasi
Escarrabill Sanglas, Joan
Roca Torrent, Josep
Keywords: Malalties pulmonars obstructives cròniques
Insuficiència cardíaca
Assistència mèdica
Telecomunicació en medicina
Chronic obstructive pulmonary diseases
Heart failure
Medical care
Telecommunication in medicine
Issue Date: 30-Mar-2015
Publisher: Universiteit Utrecht
Abstract: Objectives: 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. Setting: One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388). Method: The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 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. Results: The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites. Conclusions: 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.
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It is part of: International Journal of Integrated Care, 2015, vol. 15, p. e006
ISSN: 1568-4156
Appears in Collections:Articles publicats en revistes (Medicina)

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