Study Design of the Empirical Evaluation of the AISBE Program in Catalonia

AIMS: 1) To evaluate the HH/ED as mainstream service during the last decade (2006-2015); 2) To assess healthcare value generation of during the process of large scale deployment of the HH/ED program including generation of information useful for further refinement of transitional care in AISBE; and, 3) To assess the cost-effectiveness of AISBE's integrated care services using a population-based approach. These studies will contribute to refine three core aspects of the ongoing services; that is, a) Service evaluation; b) Health risk assessment and service selection; and, c) Service workflow definition and execution.

Study 1 - It evaluates both characteristics and outcomes of the process of HH/ED deployment from 2006 to 2015 without a control group.

Study 2 - Since late 2016, HH/ED is offered as a first choice for hospitalization to patients admitted in the Emergency room of Hospital Clinic. The current program has potential for 36 home-based admissions on a 24x7 day basis. The study will cover all patients admitted in the program (estimated 1,500 candidates) using both registry data and electronic medical records. Moreover, a subset of 200 consecutive HH candidates admitted through the Emergency room at Hospital Clinic will be selected using a 1:4 ratio. They will perform a complete study adding administration of standardized questionnaires carried out during HH/ED admission, one-month and three month after HH/ED discharge.

The intervention group will receive the standard HH/ED service and it will be compared with a control group that will include the same number of patients (n=200) under conventional hospitalization. The control group will be selected from those patients admitted in the Emergency room of the Hospital Clinic, but transferred to Hospital Sagrat Cor (within AISBE) for conventional hospitalization. Inclusion of the control group will also follow 1:4 ratio. Matching between intervention and control groups will be periodically assessed by groups of 10 patients.

The study design, as described, does not include Early Discharge patients included from highly specialized programs carried out at Hospital Clinic. Consequently, an additional HH/ED group of 100 patients from those programs will be also characterized (without control group) in order to properly identify the needs of this subset of patients for transitional care.

Finally, the population-based study (Study 3) will assess the Barcelona-Esquerra as intervention group will be compared with data from the other three healthcare sectors from the city of Barcelona, taken as control groups, because they do no have well identified integrated care programs.