Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, Lleida, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain.
JMIR Mhealth Uhealth. 2021 Jan 14;9(1):e22135. doi: 10.2196/22135.
Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care.
The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients.
As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER).
A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program.
The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.
通过打破医疗服务碎片化，采用以患者为中心的预防模式，整合医疗可以提高医疗和社会保健的效率。电子健康可以成为整合医疗的关键使能技术。
本研究旨在评估为复杂慢性病患者实施移动医疗（mHealth）支持的整合医疗模式的有效性和成本效益。
作为 CONNECARE 地平线 2020 项目的一部分，在西班牙加泰罗尼亚的一个农村地区进行了一项前瞻性、实用的、两臂平行实施试验。在 3 个月的时间里，患有慢性阻塞性肺疾病或心力衰竭的老年患者及其照顾者体验了 CONNECARE 组织整合医疗模式和支持它的电子健康平台的综合效益，该平台由一个患者自我管理应用程序、一组集成传感器和一个连接不同环境专业人员的基于网络的平台组成，或常规护理。我们使用 12 项简短健康调查（SF-12）评估健康状况的变化、6 个月随访期间的非计划性就诊和入院情况，以及增量成本效益比（ICER）。
共有 48 名患者纳入整合医疗组，28 名接受常规护理的患者纳入对照组（平均年龄 82 岁，标准差 7 岁；平均 Charlson 指数 7，标准差 2）。整合医疗组患者 SF-12 身体领域得分显著增加，平均变化+3.7（SD 8.4）（P=.004），SF-12 总分平均变化+5.8（SD 12.8）（P=.003）；然而，两组间差异无统计学意义。整合医疗组患者非计划性就诊减少 57%（P=.004），与主要慢性疾病相关的住院减少 50%（P=.32）。整合医疗计划在不同的成本方案中产生了节约，增量成本效益比表明该计划具有成本效益。
实施以患者为中心的 mHealth 支持的整合医疗模式，赋予患者权力，并连接初级、医院和社会保健专业人员，可以减少与卫生系统的非计划性接触和卫生保健成本，并且具有成本效益。这些发现支持了以 mHealth 为支撑的全系统跨组织护理途径的概念，这是实施整合医疗的成功途径。
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