Cano Isaac, Alonso Albert, Hernandez Carme, Burgos Felip, Barberan-Garcia Anael, Roldan Jim, Roca Josep
Hospital Clínic, IDIBAPS, CIBERES, Universitat de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.
Hospital Clínic, IDIBAPS, CIBERES, Universitat de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.
J Biomed Inform. 2015 Jun;55:11-22. doi: 10.1016/j.jbi.2015.02.011. Epub 2015 Mar 18.
Extensive deployment and sustainability of integrated care services (ICS) constitute an unmet need to reduce the burden of chronic conditions. The European Union project NEXES (2008-2013) assessed the deployment of four ICS encompassing the spectrum of severity of chronic patients.
The current study aims to (i) describe the open source Adaptive Case Management (ACM) system (Linkcare®) developed to support the deployment of ICS at the level of healthcare district; (ii) to evaluate its performance; and, (iii) to identify key challenges for regional deployment of ICS.
We first defined a conceptual model for ICS management and execution composed of five main stages. We then specified an associated logical model considering the dynamic runtime of ACM. Finally, we implemented the four ICS as a physical model with an ICS editor to allow professionals (case managers) to play active roles in adapting the system to their needs. Instances of ICS were then run in Linkcare®. Four ICS provided a framework for evaluating the system: Wellness and Rehabilitation (W&R) (number of patients enrolled in the study (n)=173); Enhanced Care (EC) in frail chronic patients to prevent hospital admissions, (n=848); Home Hospitalization and Early Discharge (HH/ED) (n=2314); and, Support to remote diagnosis (Support) (n=7793). The method for assessment of telemedicine applications (MAST) was used for iterative evaluation.
Linkcare® supports ACM with shared-care plans across healthcare tiers and offers integration with provider-specific electronic health records. Linkcare® successfully contributed to the deployment of the four ICS: W&R facilitated long-term sustainability of training effects (p<0.01) and active life style (p<0.03); EC showed significant positive outcomes (p<0.05); HH/ED reduced on average 5 in-hospital days per patient with a 30-d re-admission rate of 10%; and, Support, enhanced community-based quality forced spirometry testing (p<0.01). Key challenges for regional deployment of personalized care were identified.
Linkcare® provided the required functionalities to support integrated care adopting an ACM model, and it showed adaptive potential for its implementation in different health scenarios. The research generated strategies that contributed to face the challenges of the transition toward personalized medicine for chronic patients.
综合护理服务（ICS）的广泛部署和可持续性是减轻慢性病负担的一项未得到满足的需求。欧盟项目NEXES（2008 - 2013年）评估了涵盖慢性病患者严重程度范围的四种ICS的部署情况。
本研究旨在（i）描述为支持在医疗保健区层面部署ICS而开发的开源适应性病例管理（ACM）系统（Linkcare®）；（ii）评估其性能；以及（iii）确定ICS区域部署的关键挑战。
我们首先定义了一个由五个主要阶段组成的ICS管理和执行概念模型。然后，考虑到ACM的动态运行时，指定了一个相关的逻辑模型。最后，我们使用ICS编辑器将这四种ICS作为物理模型实施，以使专业人员（病例管理人员）能够积极参与使系统适应他们的需求。然后，ICS实例在Linkcare®中运行。四种ICS为评估该系统提供了一个框架：健康与康复（W&R）（研究纳入患者数量（n） = 173）；针对体弱慢性病患者预防住院的强化护理（EC）（n = 848）；家庭住院和早期出院（HH/ED）（n = 2314）；以及远程诊断支持（Support）（n = 7793）。采用远程医疗应用评估方法（MAST）进行迭代评估。
Linkcare®通过跨医疗层级的共享护理计划支持ACM，并与特定供应商的电子健康记录实现集成。Linkcare®成功推动了四种ICS的部署：W&R促进了培训效果的长期可持续性（p < 0.01）和积极生活方式（p < 0.03）；EC显示出显著的积极结果（p < 0.05）；HH/ED使每位患者平均减少5个住院日，30天再入院率为10%；Support提高了基于社区的质量强制肺活量测试（p < 0.01）。确定了个性化护理区域部署的关键挑战。
Linkcare®提供了支持采用ACM模型的综合护理所需的功能，并显示出在不同健康场景中实施的适应潜力。该研究产生了有助于应对向慢性病患者个性化医疗过渡挑战的策略。
