Cost-utility analysis of an integrated care model for multimorbid patients based on a clinical trial

Lanzeta, Itziar; Mar, Javier; Arrospide, Arantzazu

doi:10.1016/j.gaceta.2016.05.002

Cited by 18 publications

(29 citation statements)

References 16 publications

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“…Compared to a conventional model, simulation results pointed to a reduction in costs by 89% for the group of patients of less than eighty years and with three or more morbidities (24) . In addition to acting as a connection between the hospital and PHC, the nurse liaison can contribute to other settings, such as discharge from ICU patients to hospital units, as well as the transmission of up-to-date information between nurse in the surgical center and family members (25)(26) , which may improve the articulation between the units of the same health institution, strengthen communication and the bond between professionals and family members.…”

Section: Discussionmentioning

confidence: 88%

Nurse liaison: a strategy for counter-referral

et al. 2018

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Objective: to identify the profi le of the counter-referred patients by the "nurse liaison" and to describe the experience of the professionals who participated in the project. Method: intervention research, with twelve nursing nurses from a hospital and an Emergency Care Unit, and 26 nurses from Primary Health Care. Data were obtained through questionnaires and counter-referral forms. Results: Out of 43 counter-referred individuals, 62.8% are over sixty years, 53.5% are men with multi-pathologies. Among the positive aspects, the nurses highlighted the dialogue between health care services, agility in the acquisition of inputs for the continuity of care in primary care, benefi ting patients after hospital discharge. The greatest challenge was the lack of time and the defi cit of nurses to perform the function. Final considerations: the presence of the "nurse liaison" has proved to be an important strategy to improve integration between services and to promote continuity of care.

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Section: Discussionmentioning

confidence: 88%

Nurse liaison: a strategy for counter-referral

et al. 2018

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“…The most common types of economic evaluations were cost-utility analysis [31323334353637383940414243444546474849], followed by cost-consequence [5051525354555657585960616263], cost-effectiveness [64656667] and cost-comparison analysis [6869707172]. For more information on the different types of economic evaluations, please see Drummond et al [19].…”

Section: Resultsmentioning

confidence: 99%

Methodological Quality of Economic Evaluations in Integrated Care: Evidence from a Systematic Review

et al. 2019

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Introduction:The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies.Theory and methods:Searches of grey-literature and scientific papers were performed, from January 2000 to December 2018. A checklist was developed to assess the quality of economic evaluations. Authors’ statements of challenges encountered during their evaluations were qualitatively coded.Results:Forty-four articles were eligible for inclusion. The review found that study design, measurement of cost and outcomes, statistical analysis and presentation of data were the areas with most quality variation. Authors identified challenges mostly related to time horizon of the evaluation, inadequate or lack of comparator group, contamination bias, and a post-hoc evaluation culture.Discussion:Our review found significant differences in quality, with some studies showing poor methodological rigor; challenging conclusions on the cost-effectiveness of integrated care.Conclusion:It is essential for evaluators to use best-practice standards when planning and conducting economic evaluations, in order to build a reliable evidence base for decision-making in integrated care.

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Section: Introductionmentioning

confidence: 99%

“…However, evidence has shown that case management programs are not cost-effective in comparison to nonintegrated care programs for high-risk patients [ 7 , 8 , 14 ]. Case management interventions are not suitable for all high-risk patients but for a subset of patients who would benefit from them [ 14 ]. In other words, the population they target is heterogeneous and has different needs [ 10 , 15 – 17 ], yet all patients are treated in a uniform manner under the same case management strategy.…”

Section: Introductionmentioning

confidence: 99%

Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis

Azcona

Iriso

Hita

2020

BMC Health Serv Res

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Background: The purpose of this study was to produce a risk stratification within a population of high-risk patients with multiple chronic conditions who are currently treated under a case management program and to explore the existence of different risk subgroups. Different care strategies were then suggested for healthcare reform according to the characteristics of each subgroup. Methods: All high-risk multimorbid patients from a case management program in the Navarra region of Spain were included in the study (n = 885). A 1-year mortality risk score was estimated for each patient by logistic regression. The population was then divided into subgroups according to the patients' estimated risk scores. We used cluster analysis to produce the stratification with Ward's linkage hierarchical algorithm. The characteristics of the resulting subgroups were analyzed, and post hoc pairwise tests were performed. Results: Three distinct risk strata were found, containing 45, 38 and 17% of patients. Age increased from cluster to cluster, and functional status, clinical severity, nursing needs and nutritional values deteriorated. Patients in cluster 1 had lower renal deterioration values, and patients in cluster 3 had higher rates of pressure skin ulcers, higher rates of cerebrovascular disease and dementia, and lower prevalence rates of chronic obstructive pulmonary disease. Conclusions: This study demonstrates the existence of distinct subgroups within a population of high-risk patients with multiple chronic conditions. Current case management integrated care programs use a uniform treatment strategy for patients who have diverse needs. Alternative treatment strategies should be considered to fit the needs of each patient subgroup.

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Cost-utility analysis of an integrated care model for multimorbid patients based on a clinical trial

Abstract: The integrated model was not suitable for all study patients. However, the subgroup analysis identified a narrow target population that should be analysed in future studies.

Cited by 18 publications

References 16 publications

Nurse liaison: a strategy for counter-referral

Nurse liaison: a strategy for counter-referral

Methodological Quality of Economic Evaluations in Integrated Care: Evidence from a Systematic Review

Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis

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