Cost-effectiveness of the ‘Walcheren Integrated Care Model’ intervention for community-dwelling frail elderly

Background Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.

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The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: A systematic review

Health & Social Care in the Community ◽

10.1111/hsc.12571 ◽

2018 ◽

Vol 27 (1) ◽

pp. 1-30 ◽

Cited By ~ 13

Author(s):

Wilhelmina Mijntje Looman ◽

Robbert Huijsman ◽

Isabelle Natalina Fabbricotti

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Older People ◽

Integrated Care ◽

Community Dwelling ◽

Frail Older People ◽

The Cost

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Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study (Preprint)

10.2196/preprints.22135 ◽

2020 ◽

Author(s):

Jordi de Batlle ◽

Mireia Massip ◽

Eloisa Vargiu ◽

Nuria Nadal ◽

Araceli Fuentes ◽

...

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Integrated Care ◽

Mobile Health ◽

Social Care ◽

Short Form ◽

Care Model ◽

Chronic Patients ◽

Patient Centered ◽

Health And Social Care

BACKGROUND Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. OBJECTIVE The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. METHODS As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). RESULTS A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. CONCLUSIONS The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.

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The effects of an integrated care model on frail elderly

International Journal of Integrated Care ◽

10.5334/ijic.1015 ◽

2012 ◽

Vol 12 (7) ◽

Author(s):

W.M. Looman ◽

I.N. Fabbricotti

Keyword(s):

Integrated Care ◽

Frail Elderly ◽

Care Model

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Up-scaling of an integrated care model for frail elderly patients

International Journal of Integrated Care ◽

10.5334/ijic.2799 ◽

2016 ◽

Vol 16 (6) ◽

pp. 251 ◽

Cited By ~ 1

Author(s):

Marisa Merino ◽

Mariluz Marqués ◽

Marivi Egurbide ◽

Maribel Romo ◽

Isabel Rodríguez ◽

...

Keyword(s):

Elderly Patients ◽

Integrated Care ◽

Frail Elderly ◽

Care Model ◽

Up Scaling

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Effect of an integrated care model for pre-frail and frail older people living in community

Age and Ageing ◽

10.1093/ageing/afaa087 ◽

2020 ◽

Vol 49 (6) ◽

pp. 1048-1055

Author(s):

Ruby Yu ◽

Cecilia Tong ◽

Jean Woo

Keyword(s):

Health Services ◽

Older People ◽

Integrated Care ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Care Model ◽

Health And Social Care ◽

Community Dwelling Older People

Abstract Objectives to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people. Design a quasi-experimental design. Setting and participants we enrolled people aged ≥60 years from a community care project. An inclusion criterion was pre-frailty/frailty, as measured by a simple frailty questionnaire (FRAIL) with a score of ≥1. Methods we assigned participants to an intervention group (n = 183) in which they received an integrated intervention (in-depth assessment, personalised care plans and coordinated care) or a control group (n = 270) in which they received a group education session on frailty prevention. The outcomes were changes in frailty, individual domains of frailty (‘fatigue’, ‘resistance’, ‘ambulation’, ‘illnesses’ and ‘loss of weight’) and health services utilisation over 12 months. Assessments were conducted at baseline and at the 12-month follow-up. Results the mean age of the participants (n = 453) at baseline was 76.1 ± 7.5 years, and 363 (80.1%) were women. At follow-up, the intervention group showed significantly greater reductions in FRAIL scores than the control group (P < 0.033). In addition, 22.4% of the intervention and 13.7% of the control participants had reverted from pre-frail/frail to robust status, with the difference reaching significance when the intervention was compared with the control group (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0–2.4) after adjustments for age, sex, living arrangement/marital status and hypercholesterolemia. For individual domains of frailty, the adjusted OR for improved ‘resistance’ was 1.7 (95% CI 1.0–2.8). However, no effects were found on reducing use of health services. Conclusion the integrated health and social care model reduced FRAIL scores in a combined population of pre-frail/frail community-dwelling older people attending older people’s centres.

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