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

Jordi De Batlle,Araceli Fuentes,Gerard Torres,Eloisa Vargiu,Nuria Nadal,Felip Miralles,Marta Ortega Bravo,Mireia Massip,Ferran Barbé

doi:10.2196/22135

Abstract

BackgroundIntegrated 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.ObjectiveThe 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.MethodsAs 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).ResultsA 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.ConclusionsThe 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.

Highlights

The last decades have led to rapidly aging populations and an increased burden of chronic diseases [1]
Integrated care models aim to generate health and social care efficiencies through the defragmentation of care, promotion of collaboration and continuity of care across settings, adoption of patient-centered models, and prioritization of preventive models [4]. Few of these models have attempted to and succeeded in simultaneously tackling all of the above-mentioned measures [4]. eHealth and mobile health can be the key enabling technologies allowing for such a paradigm shift [5]
After excluding patients not meeting the inclusion criteria, 52 patients were recruited for the mobile health (mHealth)-enabled integrated care arm and 35 patients were recruited for the usual care arm

Summary

Introduction

The last decades have led to rapidly aging populations and an increased burden of chronic diseases [1] In this scenario, health and social care providers struggle to contain costs while providing an adequate response to the population’s care needs. Integrated care models aim to generate health and social care efficiencies through the defragmentation of care, promotion of collaboration and continuity of care across settings, adoption of patient-centered models, and prioritization of preventive models [4]. Few of these models have attempted to and succeeded in simultaneously tackling all of the above-mentioned measures [4]. 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

Methods

Results

Conclusion