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

Mateo-Abad, Maider; Fullaondo, Ane; Merino, Marisa; Gris, Stefano; Marchet, Francesco; Avolio, Francesca; Graps, Elisabetta; Ravic, Mario; Kovač, Mario; Benković, Vanesa; Stevanović, Ranko; Zwiefka, Antoni; Davies, Daniel; Mancin, Silvia; Forestiero, Antonella; Stafylas, Panagiotis; Hurtado, Mayte; ́Angelantonio, Marco D; Daugbjerg, Signe; Pedersen, Christian Bonde; Hammerschmidt, Reinhard; Stroetmann, Veli; Azkargorta, Lierni; Giné, Anna; Verdoy, Dolores; Soto-Gordoa, Myriam; Mora, Joana; Mar, Javier; Vergara, Itziar; Keenoy, Esteban de Manuel; group, On behalf of the CareWell project

doi:10.5334/ijic.4711

Cited by 19 publications

(53 citation statements)

References 24 publications

(21 reference statements)

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“…On the other hand, the maximum cut‐off age for inclusion reported in 10 studies (14.9%) ranged between 58 (Mattei da Silva et al., 2020) and 85 (Cooney et al., 2015) years old. Other selection criteria mainly focused on being frequent users of the services (Hudon et al., 2018, 2019) or being classified as complex according to a risk stratification (e.g., Mateo‐Abad, Fullaondo, et al., 2020; Mateo‐Abad, González, et al., 2020), absence of cognitive impairment or psychiatric disorders (Holtrop et al., 2017; Hotu et al., 2010), cancer and short life expectancy – range between 3 and 12 months (Ciccone et al., 2010; van den Dries et al., 2020), pregnancy (Luo et al., 2018), severe renal disease and dialysis (Ku & Kegels, 2014), insufficient language skills (Frei et al., 2014).…”

Section: Resultsmentioning

confidence: 99%

Organisational models in primary health care to manage chronic conditions: A scoping review

Longhini

Canzan

Mezzalira

et al. 2021

Health Social Care Comm

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Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.

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Section: Resultsmentioning

confidence: 99%

Organisational models in primary health care to manage chronic conditions: A scoping review

Longhini

Canzan

Mezzalira

et al. 2021

Health Social Care Comm

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“…‘ICT’ refers to the various technological tools and resources used to collect, store, retrieve, create, share or transmit information, including computers, the internet (websites and email), live broadcast technology (television and radio), recorded broadcast technology (audio and video players as well as storage devices) and telephony (fixed or mobile telephones, visual/video conferencing, etc). 31 We will conduct research selection and data extraction based on 12 relevant ICT tools for integrated care support as defined by Mateo-Abad et al , 32 including electronic prescriptions, messaging between clinicians and patients, electronic health records, interconsultation, call centres, virtual conferences, personal health folders, nurse information systems, educational platforms, collaborative platforms, telemonitoring and multichannel centres.…”

Section: Methods and Analysismentioning

confidence: 99%

Integrated care for older people based on information and communication technology: a scoping review protocol

et al. 2022

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IntroductionIntegrated care is an effective means of coping with the increasingly complex healthcare needs of elderly and alleviating pressure on national pension services. WHO regards integrated care as a method of providing high-quality healthcare and advocates integrated care based on digital technology. Against the backdrop of the COVID-19 pandemic, information and communication technology (ICT) has become a facilitator for the successful implementation of integrated care by providing a platform for information sharing, team communication and resource integration. This scoping review aims to assess internationally published evidence concerning experiences and practice of ICT-based implementation of integrated care for older people.Methods and analysisThe study will follow the research framework developed by Arksey and O’Malley for scoping reviews. We will conduct a systematic search of the literature published from January 2000 to March 2022 via electronic databases, grey literature databases, websites of key organisations and project funding sources, key journals and reference lists included in selected papers, employ the Joanna Briggs Institute Literature Quality Assessment Tool to assess the quality of the included literature and apply thematic analysis to sort and summarise the content of the included studies. This study will begin in March 2022 and will be completed in December 2022.Ethics and disseminationEthical approval for this scoping review was granted by the Academic Committee of Zhengzhou University (ZZUIRB2021-155). This study will summarise the modes of operation and effects, barriers and facilitators of ICT-based implementation of integrated care for older people. We propose to recruit older people and integrated care service providers in rural primary healthcare centres and use a structured process of concept mapping to consult and discuss the results of our scoping review to construct an integrated care model and service pathway for older adults that is appropriate to the Chinese social context.

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“…Management of DM patients requires a care system that has a network of different carers and healthcare professionals working in interdisciplinary teams 4 . Integrated care involving both primary care clinics and diabetes centers is effective for managing DM geriatric patients in terms of improving quality of care 5 , reducing emergency room visits and increasing visits to GPs and primary care nurses 6 , reducing hospitalizations for diabetes complications 7 , lowering the risk of cardiovascular events including strokes 8 , and reducing mortality for all causes and cardiovascular events 8,9 .…”

Section: Appendixmentioning

confidence: 99%

Care networks, integrated care models, and primary care

Medea¹

2021

JGG

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

Cited by 19 publications

References 24 publications

Organisational models in primary health care to manage chronic conditions: A scoping review

Organisational models in primary health care to manage chronic conditions: A scoping review

Integrated care for older people based on information and communication technology: a scoping review protocol

Care networks, integrated care models, and primary care

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