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

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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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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Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Patients and Professionals’ Acceptability Study

JMIR mhealth and uhealth ◽

10.2196/22136 ◽

2020 ◽

Vol 8 (11) ◽

pp. e22136

Author(s):

Jordi de Batlle ◽

Mireia Massip ◽

Eloisa Vargiu ◽

Nuria Nadal ◽

Araceli Fuentes ◽

...

Keyword(s):

Usual Care ◽

Integrated Care ◽

Continuity Of Care ◽

Mobile Health ◽

Health Care Professionals ◽

Lessons Learned ◽

Assessment Process ◽

Chronic Patients ◽

Health And Social Care ◽

System Usability Scale

Background Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. Objective This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. Methods As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). Results The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals’ acceptability was low (UC1: NPS −25%; UC2: NPS −35%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight. Conclusions The mHealth-enabled IC model showed outstanding results from the patients’ perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults.

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Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Patients and Professionals’ Acceptability Study (Preprint)

10.2196/preprints.22136 ◽

2020 ◽

Author(s):

Jordi de Batlle ◽

Mireia Massip ◽

Eloisa Vargiu ◽

Nuria Nadal ◽

Araceli Fuentes ◽

...

Keyword(s):

Usual Care ◽

Integrated Care ◽

Continuity Of Care ◽

Mobile Health ◽

Health Care Professionals ◽

Lessons Learned ◽

Assessment Process ◽

Chronic Patients ◽

Health And Social Care ◽

System Usability Scale

BACKGROUND Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. OBJECTIVE This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. METHODS As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). RESULTS The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals’ acceptability was low (UC1: NPS −25%; UC2: NPS −35%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight. CONCLUSIONS The mHealth-enabled IC model showed outstanding results from the patients’ perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults.

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Cost-effectiveness of cognitive–behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.125286 ◽

2014 ◽

Vol 204 (1) ◽

pp. 69-76 ◽

Cited By ~ 14

Author(s):

Sandra Hollinghurst ◽

Fran E. Carroll ◽

Anna Abel ◽

John Campbell ◽

Anne Garland ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Usual Care ◽

Social Care ◽

Cost Effective ◽

Behavioural Therapy ◽

Treatment Resistant ◽

Cognitive Behavioural ◽

Health And Social Care ◽

Resistant Depression

BackgroundDepression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.AimsTo assess the cost-effectiveness of cognitive–behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.MethodEconomic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).ResultsThe mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.ConclusionsThe addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.

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Is It Time for a Change? A Cost-Effectiveness Analysis Comparing a Multidisciplinary Integrated Care Model for Residential Homes to Usual Care

PLoS ONE ◽

10.1371/journal.pone.0037444 ◽

2012 ◽

Vol 7 (5) ◽

pp. e37444 ◽

Cited By ~ 13

Author(s):

Janet L. MacNeil Vroomen ◽

Marijke Boorsma ◽

Judith E. Bosmans ◽

Dinnus H. M. Frijters ◽

Giel Nijpels ◽

...

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Integrated Care ◽

Cost Effectiveness Analysis ◽

Care Model ◽

Residential Homes ◽

Effectiveness Analysis

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BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments

JMIR Medical Informatics ◽

10.2196/20938 ◽

2020 ◽

Vol 8 (10) ◽

pp. e20938

Author(s):

Jordi Piera-Jiménez ◽

Signe Daugbjerg ◽

Panagiotis Stafylas ◽

Ingo Meyer ◽

Sonja Müller ◽

...

Keyword(s):

Cost Effectiveness ◽

Integrated Care ◽

Information And Communication Technology ◽

Communication Technology ◽

Social Care ◽

Intervention Group ◽

Domiciliary Care ◽

Comparator Group ◽

Health And Social Care ◽

Information And Communication

Background Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce. Objective The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain. Methods A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology–enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months. Results The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI –4.51 to 4.78; P=.95) but decreased in the comparator group (mean change –3.23, 95% CI –5.34 to –1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of –0.23 (95% CI –0.44 to –0.02; P=.03) and –0.33 (95% CI –0.46 to –0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI –0.44 to 1.01, P=.44; comparator: mean change –0.29, 95% CI –0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582). Conclusions The information and communication technology–enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved. Trial Registration ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004

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BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments (Preprint)

10.2196/preprints.20938 ◽

2020 ◽

Author(s):

Jordi Piera-Jiménez ◽

Signe Daugbjerg ◽

Panagiotis Stafylas ◽

Ingo Meyer ◽

Sonja Müller ◽

...

Keyword(s):

Cost Effectiveness ◽

Integrated Care ◽

Information And Communication Technology ◽

Communication Technology ◽

Social Care ◽

Intervention Group ◽

Domiciliary Care ◽

Comparator Group ◽

Health And Social Care ◽

Information And Communication

BACKGROUND Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce. OBJECTIVE The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain. METHODS A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology–enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months. RESULTS The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI –4.51 to 4.78; P=.95) but decreased in the comparator group (mean change –3.23, 95% CI –5.34 to –1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of –0.23 (95% CI –0.44 to –0.02; P=.03) and –0.33 (95% CI –0.46 to –0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI –0.44 to 1.01, P=.44; comparator: mean change –0.29, 95% CI –0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582). CONCLUSIONS The information and communication technology–enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved. CLINICALTRIAL ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004

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A micro credential for interoperability

Open Research Europe ◽

10.12688/openreseurope.14083.1 ◽

2021 ◽

Vol 1 ◽

pp. 109

Author(s):

Pamela Hussey ◽

Subhashis Das

Keyword(s):

Integrated Care ◽

Social Care ◽

Care Delivery ◽

Point Of Care ◽

Information And Communications Technology ◽

Care Providers ◽

Patient Centered ◽

Care Programme ◽

Care Services ◽

Health And Social Care

In the midst of a global pandemic the need for health and social care providers to commit to, and deliver on, integrated patient-centered care services has been accelerated. Globally, health and social care programme administrators are turning to digital devices and applications to provide supporting infrastructure which can offer safe access to health information at the point of care. Digitalisation is increasingly considered a key requirement to support diagnostics and therapeutic care services in health care delivery. The open source community are responding to this need to advance integrated care and digital services by providing targeted resources to address the interoperability challenge. Addressing interoperability in health systems is a core part of achieving sustainable enterprise wide integrated care. Using Open Innovation 2.0 methods for advancing knowledge on interoperability, this paper describes the development of a micro credential for knowledge transfer on interoperability created by the Centre for eIntegrated Care (CeIC). Designed and developed to signpost interested stakeholders to targeted material and build understanding and capacity on the topic. The design approach and initial resource content are explained through the lens of a specific research project funded by an Elite S Fellowship to advance leadership and standardisation for Information and Communications Technology (ICT) in Europe.

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Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial (Preprint)

10.2196/preprints.28320 ◽

2021 ◽

Author(s):

Jordi Colomina ◽

Reis Drudis ◽

Montserrat Torra ◽

Francesc Pallisó ◽

Mireia Massip ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Integrated Care ◽

Knee Arthroplasty ◽

Short Form ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Chronic Patients ◽

Total Hip

BACKGROUND Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. OBJECTIVE This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. METHODS As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC 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 (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. RESULTS A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. CONCLUSIONS Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery.

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