ObjectiveTo determine associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents, nursing home staff, and healthcare workers.DesignProspective cohort study.SettingNursing homes and linked electronic medical record, test, and mortality data in Catalonia on 27 December 2020.Participants28 456 nursing home residents, 26 170 nursing home staff, and 61 791 healthcare workers.Main outcome measuresParticipants were followed until the earliest outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Mixed effects Cox models were fitted to estimate hazard ratios with index month as a fixed effect and adjusted for confounders including sociodemographics, comorbidity, and previous medicine use.ResultsAmong the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period. In parallel, 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection, but fewer than five were admitted or died with covid-19. The adjusted hazard ratio for SARS-CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) for nursing home staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two doses of vaccine were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04), respectively, for nursing home residents. Nursing home staff and healthcare workers recorded insufficient events for mortality analysis.ConclusionsVaccination was associated with 80-91% reduction in SARS-CoV-2 infection in all three cohorts and greater reductions in hospital admissions and mortality among nursing home residents for up to five months. More data are needed on longer term effects of covid-19 vaccines.

The ageing of the population and the increase in people with chronic illnesses is a scenario that creates important challenges on how to organise and provide services for this population group. There is already experience and evidence that would help us to re-think about what are the key aspects that should be taken into account to design a simple health model directed towards this new paradigm.The clinical care approach in itself is important, but at the same time, limited. A multidimensional approach is required where different elements, such as real platforms for change, are incorporated; the contribution that can be made by information systems, the objectives that should be assigned cross-sectionally to different organisations and professionals, the clinical and relational skills that should be contemplated in training and skill development plans or how the provision should be financed. Also, only interacting with some of these elements could give rise to a significant change in the care of chronic patients, particularly those in a highly complex and vulnerable situation.

Introduction The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011–2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. Method The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. Results It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. Discussion The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come.

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BackgroundA growing number of EU citizens suffers from diabetes, posing an emerging health, social and economic burden in the EU [1]. This burden is mostly driven by type 2 diabetes mellitus (T2DM), which is increasingly diagnosed at younger age and leads to a rising number of adults with T2DM aged 65 and older [1]. Due to these rising numbers in diabetes prevalence a growing number of patients faces accompanying comorbidities as well as complex needs [2][3][4][5]. However, many care systems are historically built on separate sectors (health vs. social care, in-vs. outpatient care). This traditional acute and episodic focus of care is inadequate to effectively meet the complex needs of patients as it increases the risk of care fragmentation and loss of information [6,7]. Although these circumstances are repetitively part of health policy initiatives [8,9], there is still an institutional and regulatory separation between health and social care services, as well as between ambulatory and inpatient care [10].Integrated care is said to improve outcomes of care by linking services of providers along the continuum of care and thus overcoming issues of fragmentation [11]. Back in 1996, Ed Wagner developed the Chronic Care Model (CCM), which became a cornerstone to improve care delivery for chronically ill patients. The CCM comprises the following six components: (1) community, (2) health system, (3) self-management support, (4) delivery system design, (5) decision support and (6) clinical information systems [12]. Ever since, different initiatives developed new models targeting specific weaknesses of the initial CCM.However, recent analysis uncovered that the understanding of established models' impact on chronic disease management is limited [13]. This is especially true for the effectiveness and applicability of chronic care models in different populations and settings [13]. Additionally, on behalf of the MANAGE CARE Study Group Background: Most current care models are disease-or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Method: An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. Results: The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. Conclusion: The MANAGE CARE MODEL provides...

Building a model of integrated care (ic) in home care (hc)

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Background: Predictive risk modeling elaborated from large population-based datasets using citizens traits, including historical information on use of healthcare resources, as potential predictors have shown to be useful mainly for two purposes: (i) to design health policies, with a preventive approach, in a given geographical area; and, (ii) to identify individuals with high risk for presenting undesirable health events (case finding) such as hospital admissions, functional decline and/or death. The ACT (Advancing Care Coordination and Telehealth deployment) programme is fully aligned with the European Innovation Partnership on Active and Healthy Aging (EIP on AHA)