Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study

Background: 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. Objective: The aim of this study was to assess the effectiveness and cost...

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Autores: Batlle Garcia, Jordi de, Massip, Mireia, Vargiu, Eloisa, Nadal Braque, Núria, Fuentes Botargues, Araceli, Ortega Bravo, Marta, Miralles, Felip, Barbé Illa, Ferran, Torres, Gerard
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10459.1/71194
Acceso en línea:https://doi.org/10.2196/22135
http://hdl.handle.net/10459.1/71194
Access Level:acceso abierto
Palabra clave:Chronic disease
Cost-benefit analysis
Delivery of health care
Integrated
mHealth
eHealth
Quality of life
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spelling Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness StudyBatlle Garcia, Jordi deMassip, MireiaVargiu, EloisaNadal Braque, NúriaFuentes Botargues, AraceliOrtega Bravo, MartaMiralles, FelipBarbé Illa, FerranTorres, GerardChronic diseaseCost-benefit analysisDelivery of health careIntegratedmHealtheHealthQuality of lifeBackground: 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. Objective: 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. Methods: 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). Results: 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. Conclusions: 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.This work was supported by the European Union’s Horizon 2020 Research and Innovation Program (under grant agreement GA-689802). JdB acknowledges receiving financial support from the Catalan Health Department (Pla Estratègic de Recerca i Innovació en Salut [PERIS] 2016: SLT002/16/00364) and Instituto de Salud Carlos III (ISCIII; Miguel Servet 2019: CP19/00108), cofunded by the European Social Fund (ESF), “Investing in your future.”JMIR PublicationsCONNECARE-Lleida Group202120212021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://doi.org/10.2196/22135http://hdl.handle.net/10459.1/71194http://hdl.handle.net/10459.1/71194reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a https://doi.org/10.2196/22135JMIR Mhealth and Uhealth, 2021, vol. 9, num. 1, p. e22135info:eu-repo/grantAgreement/EC/H2020/689802cc-by (c) Batlle et al., 2021info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by/4.0/oai:recercat.cat:10459.1/711942026-05-29T05:05:01Z
dc.title.none.fl_str_mv Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
title Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
spellingShingle Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
Batlle Garcia, Jordi de
Chronic disease
Cost-benefit analysis
Delivery of health care
Integrated
mHealth
eHealth
Quality of life
title_short Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
title_full Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
title_fullStr Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
title_full_unstemmed Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
title_sort Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study
dc.creator.none.fl_str_mv Batlle Garcia, Jordi de
Massip, Mireia
Vargiu, Eloisa
Nadal Braque, Núria
Fuentes Botargues, Araceli
Ortega Bravo, Marta
Miralles, Felip
Barbé Illa, Ferran
Torres, Gerard
author Batlle Garcia, Jordi de
author_facet Batlle Garcia, Jordi de
Massip, Mireia
Vargiu, Eloisa
Nadal Braque, Núria
Fuentes Botargues, Araceli
Ortega Bravo, Marta
Miralles, Felip
Barbé Illa, Ferran
Torres, Gerard
author_role author
author2 Massip, Mireia
Vargiu, Eloisa
Nadal Braque, Núria
Fuentes Botargues, Araceli
Ortega Bravo, Marta
Miralles, Felip
Barbé Illa, Ferran
Torres, Gerard
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv CONNECARE-Lleida Group
dc.subject.none.fl_str_mv Chronic disease
Cost-benefit analysis
Delivery of health care
Integrated
mHealth
eHealth
Quality of life
topic Chronic disease
Cost-benefit analysis
Delivery of health care
Integrated
mHealth
eHealth
Quality of life
description Background: 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. Objective: 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. Methods: 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). Results: 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. Conclusions: 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
2021
2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://doi.org/10.2196/22135
http://hdl.handle.net/10459.1/71194
http://hdl.handle.net/10459.1/71194
url https://doi.org/10.2196/22135
http://hdl.handle.net/10459.1/71194
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a https://doi.org/10.2196/22135
JMIR Mhealth and Uhealth, 2021, vol. 9, num. 1, p. e22135
info:eu-repo/grantAgreement/EC/H2020/689802
dc.rights.none.fl_str_mv cc-by (c) Batlle et al., 2021
info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by/4.0/
rights_invalid_str_mv cc-by (c) Batlle et al., 2021
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv JMIR Publications
publisher.none.fl_str_mv JMIR Publications
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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