Impact Assessment of an Innovative Integrated Care Model for Older Complex Patients with Multimorbidity: The CareWell Project

Maider Mateo-Abad; Ane Fullaondo; Marisa Merino; Stefano Gris; Francesco Marchet; Francesca Avolio; Elisabetta Graps; Mario Ravic; Mario Kovac; Vanesa Benkovic; Ranko Stevanovic; Antoni Zwiefka; Daniel Davies; Silvia Mancin; Antonella Forestiero; Panos Stafylas; Mayte Hurtado; Marco d'Angelantonio; Signe Daugbjerg; Claus Duedal Pedersen; Reinhard Hammerschmidt; Veli Stroetmann; Lierni Azkargorta; Anna Giné; Dolores Verdoy; Myriam Soto-Gordoa; Joana Mora; Javier Mar; Itziar Vergara; Esteban de Manuel Keenoy; CareWell project group

doi:10.5334/ijic.4711

Impact Assessment of an Innovative Integrated Care Model for Older Complex Patients with Multimorbidity: The CareWell Project

Int J Integr Care. 2020 May 22;20(2):8. doi: 10.5334/ijic.4711.

Authors

Maider Mateo-Abad^{1

2}, Ane Fullaondo¹, Marisa Merino^{3

4}, Stefano Gris⁵, Francesco Marchet⁵, Francesca Avolio⁶, Elisabetta Graps⁷, Mario Ravic⁸, Mario Kovac⁹, Vanesa Benkovic¹⁰, Ranko Stevanovic¹⁰, Antoni Zwiefka¹¹, Daniel Davies¹², Silvia Mancin¹³, Antonella Forestiero¹³, Panos Stafylas¹⁴, Mayte Hurtado¹⁵, Marco d'Angelantonio¹⁵, Signe Daugbjerg¹⁶, Claus Duedal Pedersen¹⁶, Reinhard Hammerschmidt¹⁷, Veli Stroetmann¹⁷, Lierni Azkargorta³, Anna Giné¹, Dolores Verdoy¹, Myriam Soto-Gordoa^{1

4}, Joana Mora¹, Javier Mar^{2

4

18}, Itziar Vergara^{1

2

19}, Esteban de Manuel Keenoy¹; CareWell project group

Affiliations

¹ Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, ES.
² Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, ES.
³ Osakidetza Basque Health Sevice, Tolosaldea Integrated Health Care Organization, Tolosa, Basque Country, ES.
⁴ Biodonostia Health Research Institute, Donostia, Basque Country, ES.
⁵ Azienda ULSS 1 Dolomiti, Local Health Authority, Feltre, Belluno, IT.
⁶ Agenzia Regionale per la salute e Sociale - Regione Puglia, Bari, Puglia, IT.
⁷ Health Technology Assessment - UNIT, Regional Strategic Agency for Health and Social Affair (AReSS), Bari, IT.
⁸ Ericsson Nikola Tesla d.d., Zagreb, HR.
⁹ Dept. of Control and Computer Engineering, Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, HR.
¹⁰ Croatian Society for Pharmacoeconomics and Health Economics, Zagreb, HR.
¹¹ Department of Health, LSV Marshal Office, PL.
¹² Powys Teaching Health Board, Bronllys Hospital, Bronllys, Powys, UK.
¹³ Arsenàl.IT, Veneto's Research Centre for eHealth Innovation, Treviso, IT.
¹⁴ HealThink, Thessaloniki, GR.
¹⁵ Health Information Management S.A. - HIM S.A., MAST European Economic Interest Group, Brussels, BE.
¹⁶ Centre for Innovative Medical Technology, Odense University Hospital, Odense, DK.
¹⁷ Empirica Communication and Technology Research, Bonn, DE.
¹⁸ Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Mondragon, Basque Country, ES.
¹⁹ Biodonostia Health Research Institute, Primary Care Group, Donostia, Basque Country, ES.

Abstract

Objectives: To evaluate the impact in terms of use of health services, clinical outcomes, functional status, and patient's satisfaction of an integrated care program, the CareWell program, for complex patients with multimorbidity, supported by information and communication technology platforms in six European regions.

Data sources: Primary data were used and the follow-up period ranged between 8 and 12 months.

Study design: A quasi-experimental study, targeting chronic patients aged 65 or older, with 2 or more conditions - one of them necessarily being diabetes, congestive heart failure or congestive obstructive pulmonary disease. The intervention group received the integrated care program and the control group received usual care. Generalized mixed regression models were used.

Data collection: Data were obtained from individual interviews and electronic clinical records.

Principal findings: Overall, 856 patients were recruited (475 intervention and 381 control). In the intervention group, the number of visits to emergency rooms was significantly lower, and the number of visits to the general practitioners and primary care nurses was higher than in the control group.

Conclusion: The CareWell program resulted in improvements in the use of health services, strengthening the role of PC as the cornerstone of care provision for complex patients with multimorbidity.

Keywords: ICT; elderly; integrated care; multimorbidity; patient empowerment.

Grants and funding

All the authors were funded by their institutions. The CareWell integrated care pathway project is co-funded by the European Commission, within the ICT Policy Support Programme of the Competitiveness and Innovation Framework Programme (CIP; Grant Agreement No.: 620983).