Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain.
Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.
BMC Health Serv Res. 2020 Jul 3;20(1):613. doi: 10.1186/s12913-020-05473-2.
Older patients with multimorbidity have complex health and social care needs, associated with elevated use of health care resources. The aim of this study is to evaluate the impact of CareWell integrated care model for older patients with multimorbidity in the Basque Country.
The CareWell program for older patients with multimorbidity, based on the coordination between health providers, home-based care and patient empowerment, supported by information and communication technology tools. The program was deployed in four healthcare areas in the Basque Country. The control group was formed by two organizations in which the program had not been deployed and regular care procedures were applied. Participants, older patients (aged ≥65) with two or more chronic conditions (at least one being chronic obstructive pulmonary disease, chronic heart failure, or diabetes mellitus), categorized as complex according to a risk stratification algorithm, were followed up to 12 months. The impact of the program on the use of health resources, clinical effectiveness, and satisfaction was evaluated using a mixed-method approach. Semi-structured interviews were performed to assess satisfaction with the newly deployed model and mixed regression models to measure the effect of the intervention throughout the follow-up period.
Two hundred patients were recruited (101 intervention and 99 control), mostly males (63%) with a mean age of 79 years and age-adjusted Charlson Comorbidity Index of 9.7 on average. Relevant differences between the groups were observed for all dimensions. In the intervention group, the number of hospitalizations and visits to emergency centers was reduced, and the number of primary care contacts increased. Clinical changes were also observed, such as a decrease in the body mass index and blood glucose levels. The satisfaction level was high for all stakeholders.
The implementation of CareWell integrated care model changed the profile of health resource utilization, strengthening the key role of primary care and reducing the number of emergency visits and hospitalizations. The satisfaction with this model of care was high.
ClinicalTrials.gov, NCT03042039 . Registered 3 February 2017 - Retrospectively registered.
患有多种疾病的老年患者有复杂的医疗和社会护理需求，这与医疗资源的大量使用有关。本研究旨在评估 CareWell 综合护理模式对巴斯克地区患有多种疾病的老年患者的影响。
CareWell 项目针对患有多种疾病的老年患者，基于医疗服务提供者之间的协调、家庭护理和患者赋权，辅以信息和通信技术工具。该项目在巴斯克地区的四个医疗保健区实施。对照组由两个没有实施该项目的组织组成，采用常规护理程序。参与者为年龄≥65 岁、患有两种或两种以上慢性疾病（至少有一种为慢性阻塞性肺疾病、慢性心力衰竭或糖尿病）的患者，根据风险分层算法被归类为复杂患者，随访时间为 12 个月。采用混合方法评估该项目对卫生资源使用、临床效果和满意度的影响。采用半结构式访谈评估对新部署模型的满意度，采用混合回归模型测量干预在整个随访期间的效果。
共招募了 200 名患者（101 名干预组和 99 名对照组），大多数为男性（63%），平均年龄 79 岁，平均年龄调整后的 Charlson 合并症指数为 9.7。两组在所有维度上均存在显著差异。在干预组中，住院和急诊中心就诊次数减少，而初级保健就诊次数增加。还观察到了临床变化，例如体重指数和血糖水平降低。所有利益相关者的满意度均较高。
CareWell 综合护理模式的实施改变了卫生资源利用的模式，加强了初级保健的关键作用，减少了急诊就诊和住院的次数。对这种护理模式的满意度很高。
ClinicalTrials.gov，NCT03042039。注册于 2017 年 2 月 3 日-回顾性注册。
