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Title: Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case
Author: Herranz, Carmen
González Colom, Rubèn
Baltaxe, Erik
Seijas, Nuria
Asenjo, Maria
Hoedemakers, Maike
Nicolás, David
Coloma, Emmanuel
Fernández-Solà, J. (Joaquim)
Vela, Emili
Cano Franco, Isaac
Rutten-van Mölken, Maureen
Roca, Josep
Hernandez, Carme
Keywords: Atenció domiciliària
Assistència hospitalària
Medicina personalitzada
Serveis d'infermeria
Malalties cròniques
Home care services
Hospital care
Personalized medicine
Nursing services
Chronic diseases
Issue Date: 7-Sep-2022
Publisher: BioMed Central
Abstract: Background: Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain). Methods: Prospective cohort study over one year period, 2017-2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data. Results: HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified. Conclusions: We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care. Registration: (26/04/2017; NCT03130283). Keywords: Chronic care, Health Delivery Assessment, Health Services Research, Hospital at Home, Implementation Science, Multiple Criteria Decision Analysis, Triple Aim
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It is part of: BMC Health Services Research, 2022, vol. 22, p. 1313-1145
Related resource:
ISSN: 1472-6963
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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