Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case

Carme Herranz, Rubèn González‑Colom, Erik Baltaxe, Nuria Seijas, Maria Asenjo, Maaike Hoedemakers, David Nicolas, Emmanuel Coloma, Joaqim Fernandez, Emili Vela, Isaac Cano, Maureen van Molken, Josep Roca, Carme Hernandez*

*Corresponding author for this work

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Abstract

BACKGROUND: Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain). METHODS: Prospective cohort study over one year period, 2017-2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data. RESULTS: HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified. CONCLUSIONS: We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care. REGISTRATION: ClinicalTrials.gov (26/04/2017; NCT03130283).

Original languageEnglish
Article number1133
Pages (from-to)1133
Number of pages12
JournalBMC Health Services Research
Volume22
Issue number1
DOIs
Publication statusPublished - 7 Sep 2022

Bibliographical note

Funding
This article was funded by JADECARE project- HP-JA-2019—Grant Agreement
nº 951442 a European Union’s Health Program 2014–2020.

Publisher Copyright: © 2022. The Author(s).

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