Evaluación de la efectividad de un programa de atención integrada y proactiva a pacientes crónicos complejos

Abstract

ObjectiveTo assess the effectiveness of a proactive and integrated care programme to adjust the use of health resources by chronic complex patients (CCP) identified as potential high consumers according to a predictive model based on prior use and morbidity. MethodsRandomized controlled clinical trial with three parallel groups of CCP: a blinded control group (GC), usual care; a partial intervention group (GIP) reported in the EMR; a total intervention group (GIT), also reported to primary care (PC). Conducted in an integrated health care organization (IHCO), N=128,281 individuals in 2011. Dependent variables: PC visits, emergency attention, hospitalizations, pharmaceutical cost and death. Independent variables: intervention group, age, sex, area of residence, morbidity (by clinical risk group) and recurrence as CCP. Statistical analysis: ANOVA, student's t test; logistic and multiple linear regressions at the 95% confidence level. Results4,236 CCP included for the first intervention year and 4,223 for the second; recurrence as CCP 72%. Mean age 73.2 years, 54.2% women and over 70% with 2 or more chronic diseases. The number of PC visits was significantly higher for GIT than for GIP and GC. The hospital stays were significantly lower in GIP. This effect was observed in the first year and in the second year only in the new CCP. The general indicators of the IHCO were good, before and during the intervention. ConclusionsA high standard of quality, previous and during the study, and the inevitable contamination between groups, hindered the assessment of the marginal effectiveness of the program.