Impact of the CareWell integrated care model for older patients with multimorbidity: a quasi-experimental controlled study in the Basque Country

Maider Mateo-Abad, Nerea González, Ane Fullaondo, Marisa Merino, Lierni Azkargorta, Anna Giné, Dolores Verdoy, Itziar Vergara, Esteban de Manuel Keenoy, Maider Mateo-Abad, Nerea González, Ane Fullaondo, Marisa Merino, Lierni Azkargorta, Anna Giné, Dolores Verdoy, Itziar Vergara, Esteban de Manuel Keenoy

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov, NCT03042039 . Registered 3 February 2017 - Retrospectively registered.

Keywords: Care coordination; Home support; ICT; Implementation; Integrated care; Mixed-method; Multimorbidity; Older; Patient empowerment.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CareWell program pathway in the Basque Country. Diagram of the newly deployed integrated organizational model. Patients were stratified into different levels of interventions using agreed criteria for care intensification or specific actions to perform under particular circumstances
Fig. 2
Fig. 2
Diagram of the patients included. The flow of participants for control and intervention group, per site
Fig. 3
Fig. 3
Use of health resources by each group, intervention and control. Data are presented as mean (standard deviation). The data represent the rate per year, considering the follow-up period for each patient. C, control; GP, general practitioners; I, intervention; PC, primary care. Differences between groups were measured using regression models. The models were adjusted by age, gender, baseline BMI value, and age-adjusted Charlson Comorbidity Index

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