BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments

Jordi Piera-Jiménez, Signe Daugbjerg, Panagiotis Stafylas, Ingo Meyer, Sonja Müller, Leo Lewis, Paolo da Col, Frans Folkvord, Francisco Lupiáñez-Villanueva, Jordi Piera-Jiménez, Signe Daugbjerg, Panagiotis Stafylas, Ingo Meyer, Sonja Müller, Leo Lewis, Paolo da Col, Frans Folkvord, Francisco Lupiáñez-Villanueva

Abstract

Background: Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce.

Objective: The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain.

Methods: A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology-enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months.

Results: The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI -4.51 to 4.78; P=.95) but decreased in the comparator group (mean change -3.23, 95% CI -5.34 to -1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of -0.23 (95% CI -0.44 to -0.02; P=.03) and -0.33 (95% CI -0.46 to -0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI -0.44 to 1.01, P=.44; comparator: mean change -0.29, 95% CI -0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582).

Conclusions: The information and communication technology-enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved.

Trial registration: ClinicalTrials.gov NCT03111004; https://ichgcp.net/clinical-trials-registry/NCT03111004" title="See in ClinicalTrials.gov">NCT03111004.

Keywords: chronic disease; clinical effectiveness; cost-effectiveness; digital health; integrated care; telecare; telemedicine.

Conflict of interest statement

Conflicts of Interest: The authors declare no conflicts of interest. The BeyondSilos team received 50% funding for Research and Innovation from the European Union for the project. The provider of the telehealth solution (Health Insight Solutions) is a privately-owned company which was not part of the project and was subcontracted under a public tendering process by BSA.

©Jordi Piera-Jiménez, Signe Daugbjerg, Panagiotis Stafylas, Ingo Meyer, Sonja Müller, Leo Lewis, Paolo da Col, Frans Folkvord, Francisco Lupiáñez-Villanueva. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 06.10.2020.

Figures

Figure 1
Figure 1
3-state Markov model applied for the BeyondSilos cost-effectiveness analysis.
Figure 2
Figure 2
Flowchart of participant recruitment for the BeyondSilos project.
Figure 3
Figure 3
Cost-effectiveness plane for a willingness-to-pay of €15,000 (approximately US $17,481)/quality-adjusted life year. ICER: incremental cost-effectiveness ratio; QALY: quality-adjusted life year; WTP: willingness-to-pay.
Figure 4
Figure 4
Sensitivity analysis showing effects between 0% and 5% change in utilities—willingness-to-pay of €15,000 (approximately US $17,481)/quality-adjusted life year. QALY: quality-adjusted life year; WTP: willingness-to-pay.
Figure 5
Figure 5
Sensitivity analysis showing effects between 0% and 5% change in costs—willingness-to-pay of €15,000 (approximately US $17,481)/quality-adjusted life year. QALY: quality-adjusted life year; WTP: willingness-to-pay.

References

    1. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002 Feb 27;287(8):1022–8. doi: 10.1001/jama.287.8.1022.
    1. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc. 2004 Sep;52(9):1417–23. doi: 10.1111/j.1532-5415.2004.52401.x.
    1. Dainty KN, Golden BR, Hannam R, Webster F, Browne G, Mittmann N, Stern A, Zwarenstein M. A realist evaluation of value-based care delivery in home care: The influence of actors, autonomy and accountability. Soc Sci Med. 2018 Jun;206:100–109. doi: 10.1016/j.socscimed.2018.04.006.
    1. Mogensen CB, Ankersen ES, Lindberg MJ, Hansen SL, Solgaard J, Therkildsen P, Skjøt-Arkil Helene. Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness. Scand J Trauma Resusc Emerg Med. 2018 Apr 05;26(1):26. doi: 10.1186/s13049-018-0492-3.
    1. Leichsenring K. Developing integrated health and social care services for older persons in Europe. Int J Integr Care. 2004 Sep 03;4(3):e10. doi: 10.5334/ijic.107.
    1. Dickinson H, Allen K, Alcock P, Macmillan R, Glasby J. The role of the third sector in delivering social care. NIHR School for Social Care Research. 2012. [2020-05-06].
    1. Tsiachristas A, Stein KV, Evers S, Rutten-van Mölken Maureen. Performing Economic Evaluation of Integrated Care: Highway to Hell or Stairway to Heaven? Int J Integr Care. 2016 Oct 19;16(4):3. doi: 10.5334/ijic.2472.
    1. Low L, Yap M, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health Serv Res. 2011 May 09;11(1):93. doi: 10.1186/1472-6963-11-93.
    1. Booker C, Turbutt A, Fox R. Model of care for a changing healthcare system: are there foundational pillars for design? Aust. Health Review. 2016;40(2):136–140. doi: 10.1071/ah14173.
    1. Koch S, Hägglund Maria. Health informatics and the delivery of care to older people. Maturitas. 2009 Jul 20;63(3):195–9. doi: 10.1016/j.maturitas.2009.03.023.
    1. Loh KP, McHugh C, Mohile SG, Mustian K, Flannery M, Klepin H, Schnall R, Culakova E, Ramsdale E. Using Information Technology in the Assessment and Monitoring of Geriatric Oncology Patients. Curr Oncol Rep. 2018 Mar 06;20(3):25. doi: 10.1007/s11912-018-0672-3.
    1. Khosravi P, Ghapanchi AH. Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review. Int J Med Inform. 2016 Jan;85(1):17–26. doi: 10.1016/j.ijmedinf.2015.05.014.
    1. Bertoncello C, Colucci M, Baldovin T, Buja A, Baldo V. A review of reviews. Public Library of Science: Virgili G, editor. Vol. 13, PLoS ONE; 2018. How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews; p. e0207332.
    1. Kadu M, Ehrenberg N, Stein V, Tsiachristas A. Methodological Quality of Economic Evaluations in Integrated Care: Evidence from a Systematic Review. Int J Integr Care. 2019 Sep 09;19(3):17. doi: 10.5334/ijic.4675.
    1. Vondeling H. Economic evaluation of integrated care: an introduction. Int J Integr Care. 2004 Mar 01;4(1):e20. doi: 10.5334/ijic.95.
    1. BeyondSilos project Learning from integrated eCare practice and promoting deployment in European regions. CORDIS EU Research Results. 2017. Apr 25, [2020-05-06]. .
    1. Urošević Vladimir, Mitić Marko. From generic pathways to ICT-supported horizontally integrated care: the SmartCare approach and convergence with future Internet assembly. Stud Health Technol Inform. 2014;197:71–5.
    1. Lindberg B, Nilsson C, Zotterman D, Söderberg Siv, Skär Lisa. Int J Telemed Appl. Using information and communication technology in home care for communication between patients, family members, and health care professionals: a systematic review. Int J Telemed Appl. 2013; 2013. Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review; p. 461829.
    1. Burgos-Díez Carolina, Sequera-Requero RM, Tarazona-Santabalbina FJ, Contel-Segura JC, Monzó-Planella Marià, Santaeugènia-González Sebastià Josep. Study protocol of a quasi-experimental trial to compare two models of home care for older people in the primary setting. BMC Geriatr. 2020 Mar 12;20(1):101. doi: 10.1186/s12877-020-1497-0.
    1. Santaeugènia Sebastià J, Mas MA, Tarazona-Santabalbina Francisco J, García-Lázaro Manuela, Alventosa AM, Gutiérrez-Benito Alícia, Monterde A, Cunill J. Clinical effectiveness of an intermediate care inpatient model based on integrated care pathways. Geriatr Gerontol Int. 2020 Apr 18;20(4):366–372. doi: 10.1111/ggi.13877.
    1. Mas MÀ, Closa C, Gámez Sara, Inzitari M, Ribera A, Santaeugènia Sebastià J, Gallofré Miquel. Home as a Place for Care of the Oldest Stroke Patients: A Pilot from the Catalan Stroke Program. J Am Geriatr Soc. 2019 Sep 24;67(9):1979–1981. doi: 10.1111/jgs.15944.
    1. Baltaxe E, Cano I, Herranz C, Barberan-Garcia A, Hernandez C, Alonso A, Arguis MJ, Bescos C, Burgos F, Cleries M, Contel JC, de Batlle J, Islam K, Kaye R, Lahr M, Martinez-Palli G, Miralles F, Moharra M, Monterde D, Piera-Jiménez J, Ríos José, Rodriguez N, Ron R, Rutten-van Mölken Maureen, Salas T, Santaeugenia S, Schonenberg H, Solans O, Torres G, Vargiu E, Vela E, Roca J. Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols. BMC Health Serv Res. 2019 Jun 11;19(1):370. doi: 10.1186/s12913-019-4174-2.
    1. Closa C, Mas MÀ, Santaeugènia Sebastià J, Inzitari M, Ribera A, Gallofré Miquel. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care. J Am Med Dir Assoc. 2017 Sep 01;18(9):780–784. doi: 10.1016/j.jamda.2017.04.006.
    1. Mas M, Closa C, Santaeugènia Sebastià J, Inzitari M, Ribera A, Gallofré Miquel. Hospital-at-home integrated care programme for older patients with orthopaedic conditions: Early community reintegration maximising physical function. Maturitas. 2016 Jun;88:65–9. doi: 10.1016/j.maturitas.2016.03.005.
    1. Dueñas-Espín Ivan, Vela E, Pauws S, Bescos C, Cano I, Cleries M, Contel JC, de Manuel Keenoy E, Garcia-Aymerich J, Gomez-Cabrero D, Kaye R, Lahr MMH, Lluch-Ariet M, Moharra M, Monterde D, Mora J, Nalin M, Pavlickova A, Piera-Jiménez J, Ponce S, Santaeugenia S, Schonenberg H, Störk Stefan, Tegner J, Velickovski F, Westerteicher C, Roca J. Proposals for enhanced health risk assessment and stratification in an integrated care scenario. BMJ Open. 2016 Apr 15;6(4):e010301. doi: 10.1136/bmjopen-2015-010301.
    1. RossiMori A, Piera-Jiménez J, Albano V, Mercurio G. A systematic analysis of the multi-annual journey of Badalona towards integrated care. Int J Integr Care. 2019 Aug 08;19(4):344. doi: 10.5334/ijic.s3344.
    1. Rossi Mori A, Albano V, Piera-Jiménez J. Badalona Story: integrating the integration initiatives. Int J Integr Care. 2017 Oct 17;17(5):315. doi: 10.5334/ijic.3632.
    1. Moharra M, Vela E, Dueñas-Espín I, Pauws S, Bescos C, Cano I, Cleries M, Contel JC, De Manuel Keenoy E, Garcia-Aymerich J, Gómez-Cabrero D, Kaye R, Lahr MM, Lluch-Ariet M, Monterde D, Mora J, Nalin M, Pavlickova A, Piera-Jiménez J, Ponce S, Santaeugenia S, Schonenberg H, Störk S, Tegnér J, Velickovski F, Westerteicher C, Roca J. Health risk assessment and stratification in an integrated care scenario. Int J Integr Care. 2016 Dec 16;16(6):322. doi: 10.5334/ijic.2870.
    1. Mas M, Inzitari M, Sabaté S, Santaeugènia S, Miralles R. Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care. Age Ageing Jun 24. 2017;46(6):925–31. doi: 10.1093/ageing/afx099.
    1. Mas MÀ, Santaeugènia Sebastià J, Tarazona-Santabalbina FJ, Gámez Sara, Inzitari M. Effectiveness of a Hospital-at-Home Integrated Care Program as Alternative Resource for Medical Crises Care in Older Adults With Complex Chronic Conditions. J Am Med Dir Assoc. 2018 Oct;19(10):860–863. doi: 10.1016/j.jamda.2018.06.013.
    1. Bernal-Delgado E, Garcia-Armesto S, Oliva J, Sanchez Martinez FI, Repullo JR, Pena-Longobardo LM, Ridao-Lopez M, Hernandez-Quevedo C. Spain: Health System Review. Health Syst Transit. 2018 May;20(2):1–179.
    1. González-Portillo A, Arroyo G. An Approach to Social Service Systems in Europe: The Spanish Case. An Anal Contemp Soc Welf Issues. 2016;47 doi: 10.5772/65121.
    1. Izquieta Etulain JL, Callejo González JJ, Prieto Lobato JM. Third Sector and Public Administrations. Relationships at the Regional and Local Level. Rev Int Sociol. 2008 Feb 07;LXVI(49) doi: 10.3989/ris.2008.i49.85.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases. 1987 Jan;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Royal College of General Practitioners Barthel Activities of Daily Living (ADL) Index. Occas Pap R Coll Gen Pract. 1993 Apr;(59):24.
    1. Kidholm K, Ekeland AG, Jensen LK, Rasmussen J, Pedersen CD, Bowes A, Flottorp SA, Bech M. A model for assessment of telemedicine applications: MAST. Int J Technol Assess Health Care. 2012 Jan 23;28(1):44–51. doi: 10.1017/s0266462311000638.
    1. Guo HJ, Sapra A. StatPearls. StatPearls Publishing; 2020. Jan, [2020-09-28]. Instrumental Activity of Daily Living (IADL)
    1. Yesavage Ja, Sheikh Ji. Geriatric Depression Scale. Clinical Gerontologist. 2008 Oct 25;5(1-2):165–173. doi: 10.1300/J018v05n01_09.
    1. LimeSurvey: An Open Source survey tool. Limesurvey GmbH. [2020-05-06]. .
    1. Hammerschmidt R, Meyer I. Socio-economic impact assessment and business models for integrated eCare. Achieving Effective Integrated E-Care Beyond the Silos. 2014:136–163. doi: 10.4018/978-1-4666-6138-7.ch007.
    1. Hair J. Multivariate Data Analysis. New Jersey: Prentice Hall; 2010. p. 785.
    1. MAFEIP (Monitoring and Assessment Framework for the EIP on Active and Healthy Ageing) European Commission. [2020-05-06].
    1. European Innovation Partnership on Active and Healthy Ageing. European Commission. [2020-05-06]. .
    1. Briggs A, Sculpher M, Claxton K. Decision Modelling for Health Economic Evaluation. Oxford: University of Oxford Press; 2006.
    1. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 2015.
    1. Piera-Jiménez Jordi, Winters M, Broers E, Valero-Bover D, Habibovic M, Widdershoven JWMG, Folkvord F, Lupiáñez-Villanueva Francisco. Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial. J Med Internet Res. 2020 Jul 28;22(7):e17351. doi: 10.2196/17351.
    1. Kaambwa B, Billingham L, Bryan S. Mapping utility scores from the Barthel index. Eur J Health Econ. 2013 Apr 2;14(2):231–41. doi: 10.1007/s10198-011-0364-5.
    1. Neumann PJ, Sanders G, Russell L, Siegel J, Ganiats T. Cost-Effectiveness in Health and Medicine second edition. Oxford: Oxford University Press; 2016.
    1. Rovira J, Antoñanzas F. Economic analysis of health technologies and programmes. a Spanish proposal for methodological standardisation. Pharmacoeconomics. 1995 Sep;8(3):245–52. doi: 10.2165/00019053-199508030-00007.
    1. Sculpher M, Fenwick E, Claxton K. Assessing quality in decision analytic cost-effectiveness models. a suggested framework and example of application. Pharmacoeconomics. 2000 May;17(5):461–77. doi: 10.2165/00019053-200017050-00005.
    1. Vallejo-Torres L, García-Lorenzo Borja, Serrano-Aguilar P. Estimating a cost-effectiveness threshold for the Spanish NHS. Health Econ. 2018 Apr 28;27(4):746–761. doi: 10.1002/hec.3633.
    1. Tsiachristas A, Burgers L, Rutten-van Mölken Maureen P M H. Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands. Value Health. 2015 Dec;18(8):977–86. doi: 10.1016/j.jval.2015.07.007.
    1. Tsiachristas A, Cramm J, Nieboer AP, Rutten-van Mölken Maureen Pmh. Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants. Cost Eff Resour Alloc. 2014;12(1):17. doi: 10.1186/1478-7547-12-17.
    1. McDonald J, McKinlay E, Keeling S, Levack W. How family carers engage with technical health procedures in the home: a grounded theory study. BMJ Open. 2015 Jul 06;5(7):e007761. doi: 10.1136/bmjopen-2015-007761.
    1. Jennett B. Bringing the Hospital Home: Ethical and Social Implications of High-Tech Home Care. BMJ. 1996 Mar 02;312(7030):587–587. doi: 10.1136/bmj.312.7030.587a.
    1. Tsiachristas A. Payment and economic evaluation of integrated care. Int J Integr Care. 2015 Apr 22;15(2):e013. doi: 10.5334/ijic.2009.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다