Integrated Home Care Research Articles

Reducing Emergency Room’s overcrowding

Abstract Introduction The ageing of the population and the consequent increase in the epidemiology of chronic diseases pose numerous challenges at both hospital and territorial levels. In this context, one phenomenon that deserves particular attention is the frequent use of emergency services by ‘frail’ people. The aim of our study was to identify the most frequent users of the University Hospital’s Emergency Room (ER) of Siena, based on their care at territorial level. Materials and methods A retrospective study was carried out on the data of accesses to the ER of the University Hospital’s of Siena from June to September 2023. Patients were stratified according to the number of admissions, excluding those with only one admission during the study period. After identifying those with four or more accesses, the USL-TSE management system ‘Astercloud’ was used to check whether they were in integrated home care (ADI) or planned home care (ADP). Descriptive analysis was performed using STATA software. Results During the study period, 2347 patients were admitted to the ER, 78.95% had two admissions, 14.96% had three, 4.26% had four, 1.24% had five, 0.34% had six, 0.13% had seven, 0.09% had eight and, finally, 0.04% had eleven admissions. 93.1% of the sample had fewer than four admissions (2,204 patients), while 6.1% had four or more admissions (143 patients). Of the 143 patients studied, 16.1% were in home care, 13.3% in ADI and 2.8% in ADP. 36.8% of patients in ADI died within 4 months of the last admission during the period studied. Conclusions Our results suggest that the identification of people at risk of frequent use of the ER seems essential. Equally important is the existence of effective coordination and cooperation between hospitals and the community, with special attention to certain categories of patients. All of this is aimed to achieve overall appropriateness and therapeutic effectiveness, thus avoiding inappropriate admissions to the ER. Key messages • Significance of identifying individuals prone to frequent use of emergency services to underscore the need for proactive management strategies to address their healthcare needs. • Coordination and cooperation between hospital facilities and community-based services to enhance appropriateness of care and reduce inappropriate Emergency Room admissions.

A new digital model for Italian Integrated Home Care: strengths, barriers, and future implications

Abstract Issue/Problem After the COVID-19 pandemic, Italy’s National Health Service (NHS) is transforming by adopting telemedicine through its National Recovery and Resilience Plan, aiming to modernize healthcare delivery and ensure equity. In this plan Territorial Coordination Centers (COT) were designed to improve patient access and continuity of care. However, regulatory challenges hinder the widespread adoption of telemedicine. Our work describes the technical, structural, and operational aspects of the new Italian Integrated Home Care (IHC) digital model, addressing strengths, barriers, and future implications. Description of the problem The implementation of the IHC digital model faces multiple challenges. Italy’s poor technical infrastructure, especially in rural areas, hampers access to critical services. Resistance to change among rural systems and the elderly, coupled with low digital literacy, inhibits telemedicine adoption. Fragmentation in the NHS leads to resource disparities, particularly disadvantaging southern regions. Italy also grapples with a severe shortage of healthcare professionals, posing a threat to the model’s sustainability. Results The National Digital Health Agency enacts the IHC model by overseeing telemedicine services through a cloud-based protocol. Each Region provides “Basic Telemedicine Services”: healthcare professionals’ and patient teleconsultation, telemonitoring, teleassistance. Communication between services, infrastructures, and local health authorities is facilitated by a modular interoperability layer, ensuring data standards and quality. A national telemedicine dissemination portal will contain data on all telemedicine solutions provided. Lessons Clear communication is essential for telemedicine acceptance. COTs enhance coordination and management. Bridging the technology gap for disadvantaged groups, supporting frontline employees and addressing adoption factors is vital to overcome the challenges faced. Key messages • The National Digital Health Agency drives telemedicine services under the IHC model. Each region offers Basic Telemedicine Services, ensuring data standards, quality and interoperability of data. • Italy’s telemedicine adoption faces poor infrastructure, resistance and workforce shortages. Focusing on equity, healthcare workers support and bridging the technology gap will be key.

Technologies and main functionalities of the telemonitoring application reCOVeryaID.

The COVID-19 pandemic has highlighted the need to take advantage of specific and effective patient telemonitoring platforms, with specific reference to the constant monitoring of vital parameters of patients most at risk. Among the various applications developed in Italy, certainly there is reCOVeryaID, a web application aimed at remotely monitoring patients potentially, currently or no longer infected with COVID-19. Therefore, in this paper we present a system model, consisting of a multi-platform intelligent telemonitoring application, that enables remote monitoring and provision of integrated home care to both patients symptomatic, asymptomatic and pre-symptomatic with severe acute respiratory infectious disease or syndrome caused by viruses belonging to the Coronavirus family, as well as simply to people with respiratory problems and/or related diseases (chronic obstructive pulmonary disease or asthma). In fact, in this paper we focus on exposing the technologies and various functionalities offered by the system, which constitute the practical implementation of the theoretical framework described in detail in another paper. Specifically, the reCOVeryaID telemonitoring application is a stand-alone, knowledge base-supported application that can promptly react and inform physicians if dangerous trends in a patient's short- and long-term vital signs are detected, thus enabling them to be monitored continuously, both in the hospital and at home. The paper also reports an evaluation of user satisfaction, carried out by actual patients and medical doctors.

Informal Caregivers’ Awareness about the Methods of Integrated Home Care for the Elderly

Informal Caregivers’ Awareness about the Methods of Integrated Home Care for the Elderly

Impact of quality of service in the direct cost of integrated home care services

ABSTRACT The health and social care sectors grapple with challenges amid population growth and escalating service costs, necessitating enhanced management efficiency. This study centers on Quality of Service (QoS) in integrated home health and social care, assessing its impact on costs. Delving into financial considerations and user perspectives, we propose QoS measures based on consultations with stakeholders. To address the scheduling and routing problems associated with caregiver planning, we introduce a mixed integer linear programming model. We conduct a study and computational experiments to gain valuable insights into the relationship between QoS measures and the overall cost of the service. Findings empower managers to navigate the trade-off between QoS and expenses, offering valuable guidance for decision-making. Ultimately, this work contributes to the development of new strategies and approaches for more efficient and effective management of health and social care in the face of current challenges.

Analysis of predictive factors for non-adherence to organized screening for colorectal and breast cancers in the pre-pandemic period (2018-2019) in Lombardy Region (Northern Italy)

according to the International Agency for Cancer Research on Cancer, in 2022, breast cancer is the most common cancer in the Italian population, followed by colorectal cancer. Oncological screenings represent an effective secondary prevention strategy to counteract colorectal and breast cancers, significantly reducing mortality. In Lombardy Region (Northern Italy), screening programmes have been active since 2007, but adherence, especially in specific population subgroups, remains lower than expected. to analyse potential predictors of non-adherence to colorectal and breast cancer screening in the Lombardy Region during the pre-pandemic period of 2018-2019. a retrospective cohort study aimed at investigating the role of sociodemographic variables, health status, and access to the healthcare system on non-adherence to colorectal and breast cancer screening. Statistical analyses were conducted separately by each Agency for Health Protection (ATS). The results of the models were synthesized across the Lombardy region through random-effects meta-analysis. residents within the territory of each ATS in Lombardy as of 01.01.2018 and aged between 49 and 69 years at the beginning of the follow-up. adherence to colorectal and breast cancer screenings. during the study period, across the Lombardy Region, 2,820,138 individuals were eligible to participate in colorectal cancer screening, and 1,357,344 women were eligible to participate in breast cancer screening, with an invitation coverage of 87% and 86%, respectively.For breast cancer screening, older age, cardiopathy, chronic obstructive pulmonary disease (COPD), inflammatory bowel diseases (IBD), autoimmune diseases, and presence of a rare disease are associated with a reduced risk of non-adherence. Conversely, foreign citizenship, oncological diagnosis, transplant, chronic kidney disease/dialysis, diabetes, heart failure, arterial or cerebral vasculopathy, and presence of a neurological diagnosis are associated with significant excess risks of non-participation. For colorectal cancer screening, factors favouring adherence include female gender, older age, cardiopathy, COPD, autoimmune diseases, and having access/utilization of primary care. Non-adherence is associated with foreign citizenship, transplant, chronic kidney disease/dialysis, diabetes, heart failure, arterial or cerebral vasculopathy, IBD, neurological diseases, residence in assisted living facilities, use of integrated home care, and presence of disability. this is the first study conducted in the Lombardy Region which explores the theme of equity of access to organized screenings. This analysis highlights how sociodemographic determinants, chronic conditions, and access to the healthcare and social healthcare system constitute significant risk factors for non-adherence to screening programmes. Based on the results of this analysis, communication and/or organizational change interventions will be developed to counteract inequalities in access to effective prevention procedures.

Elderly People Treated in Integrated Home Care in Italian Regions: A Metric Approach

Elderly People Treated in Integrated Home Care in Italian Regions: A Metric Approach

Case management as a tool for integrated care

Introduction: Résinam and Chronicopôle are two pilot projects implemented in the Namur and Liège areas. They are part of a larger plan of 12 integrated care initiatives targeting chronically ill people. The “Case management” is a central action within the two pilot projects. Its main specificity is that it meets with a number of components of integrated care as well as needs arising from the field experience.
 Policy Context And Objective: Each territory has its own specificities. For example, we can identify home nursing coordination, integrated home care services, P3 protocols... The “case manager” is not an additional initiative. He/She intervenes up when the missions of the different structures do not allow a sufficient offer of care to the patient. His/Her intervention is therefore ad hoc and characterized by a period of crisis. His/Her main objective is to stabilize patient care while offering a treatment path that corresponds with their needs. His/Her intervention requires acting in coherence with the operating mode of the network. He/She must be able to target his/her strengths and limits of action in order to adapt his/her missions. 
 Target population: Chronically ill people in a situation of polyfragility (mental health problem and/or social insecurity)
 Highlights (innovation, impact, outcomes): The implementation of case management has been evolving (since 2018, 3 case managers have taken care of 171 patients in the Namur region) according to the specificities of the areas and to the projects that have developed the mission. 
 Nethertheless, we can identify a common process to facilitate the development of this action. It is necessary to co-construct the profile with the various stakeholders (in Namur, a working group with home care coordination and a Be-Hive researcher has been set up) in order to identify the existing processes and the unmet needs among patients.
 On the other hand, we can mention an added value for the patient namely the reactivation of available services, the networking of the various stakeholders (which goes beyond simple multidisciplinary consultation). This approach invites social interventions (CPAS, humanitarian aid centers and the social and housing services) to interact, focusing on the patient and his health.
 Conclusion: The implementation process as described is an added value in terms of change management. The action highlights the different processes of patient care and allows an improvement of the situations encountered in the most complex situations. This process requires flexibility from stakeholders and openness in terms of integrated care.
 The process of network activation and patient support requires stakeholders to be open in the process and innovative in the segmentation of services to provide quality outpatient service.
 The outpatient service also allows to work from the patient’s perspective, using communication tools that allow case managers and protagonists to work on requests while respecting the person's choice.
 This co-construction system allows the needs of each stakeholder (subsidizing power-service providers-patients) to be met and is therefore a reference as a methodology for implementing other integrated care initiatives.

A new digital model for the Italian Integrated Home Care: strengths, barriers, and future implications.

A new digital model for the Italian Integrated Home Care: strengths, barriers, and future implications.

58 Review of a pilot Reablement Team service

Abstract Background A Reablement Team (RT) was established in a level two hospital for patients who are medically fit for discharge from either Medical Assessment Unit (MAU) or in-patient care, to prevent hospital admission and to support early discharge, through the provision of home rehabilitation. The team consists of senior grade medical social worker, occupational therapist, speech and language therapist, physiotherapist and a rehabilitation assistant. Intensive rehabilitation is provided in the home for up to 6 weeks. This study sought to evaluate service impact and performance in 2022. Methods A mixed method design was employed. Quantitative data was used by analysing number and nature of patients seen, discharge outcomes and pre and post outcome measures to determine goals achieved, quality of life and independence levels. Qualitative data included patient satisfaction questionnaires. Results In 2022, 78 patients were seen, 41 female and 37 male. Mean age of 79 years. Of the total number of patients, 59 (76%) were discharged early from hospital and 19 (24%) avoided hospital admission after attending the MAU. Underlying diagnosis of patients comprised Stroke (n = 29), progressive neurological disorders (n = 11), respiratory disorders (n = 2) orthopaedic/musculoskeletal (n = 13), falls (n = 20), patients medically unwell (n = 3). Of the patients discharged, 86% remained at home (n = 67), while 14% were readmitted. Using pre/post outcome measures, 89% reported an improvement in quality of life as measured by the ICECAP assessment and the mean increase of all patients in independence was 5.4% measured on the modified Barthel index. 91% of patients achieved one or more primary rehabilitation goals. All patients rated service satisfaction as high. Conclusion Findings indicate that a RT service can reduce LOS and prevent unnecessary admissions when intensive rehabilitation is provided by a dedicated team of HSCPs in the home. Additional benefits include reduction of primary care waiting list and integrated home care.

Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments.

Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient's admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981-April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.

A suggested mortality benefit with integrated health care versus conventional home health care in Taiwan

ABSTRACT In Taiwan, the Integrated Home Care (IHC) project was introduced for medically compromised patients living at home receiving Home Health Care (HHC) in 2016. The focus of the project was on organizing care teams and managing care for patients. The aim of this study was to investigate the benefits and impacts of IHC in Taiwan. The primary outcome measure was the mortality rate of patients who received IHC versus those who did not receive IHC (non-IHC). The secondary outcomes were medical utilization and expenditure. The results showed that IHC was associated with a statistically significant reduction in mortality compared to non-IHC for home-dwelling patients over 90-, 180-, and 365-days periods. Additionally, IHC users were less likely to be hospitalized and had shorter hospitalization times compared to non-IHC users. Furthermore, IHC was found to reduce medical expenditure compared to non-IHC.

National Recovery and Resilience Plan and Health: qualitative analysis on the sustainability of the interventions on healthcare.

Sars-CoV2 epidemic was the cause of death of more than 180,000 Italian citizens. The severity of this disease showed to policymakers how easily Italian health services, and particularly hospitals, could be overwhelmed by requests and needs from patients and the general population. As a consequence of the clogging of health services, the government decided to allocate a consistent investment to the community and proximity assistance with a specific section (Mission 6) of the so called "National Recovery and Resilience Plan". The aim of this study is to analyse the economic and social impact of the Mission 6 of the National Recovery and Resilience Plan, with particular regard to the most relevant interventions (Community Homes, Community Hospitals, Integrated Home Care), in order to understand its future sustainability. A qualitative research methodology was chosen. Documents containing all the relevant information regarding the sustainability of the plan (called in short "Sustainability Plan") were taken into consideration. In case of missing data regarding the potential costs or expenditure of the aforementioned structures, estimates will be made reviewing literature for similar healthcare services, already implemented and active in Italy. Direct content analysis was chosen as the methodology for data analysis and final reporting of results. The National Recovery and Resilience Plan states that it will create savings of up to €1.18 billion thanks to the re-organization of healthcare facilities, the reduction of hospitalizations, the reduction of inappropriate access to the emergency room, and the containment of pharmaceutical expenditure. This amount will be used to cover the salaries for the healthcare professionals employed in the newly planned healthcare structures. The analysis of this study has taken into account the number of healthcare professionals that will be needed to operationalize the new facilities, as described in the plan and compared them with the reference salaries for each category (doctors, nurses, other healthcare workers). The annual cost for healthcare professionals has been stratified for each structure, with the following results: € 540 million for the personnel of the Community Hospitals ("Ospedali di Comunità"); € 1.1 billion for the personnel of Integrated Home Care Assistance ("Assistenza Domiciliare Integrata"); and € 540 million for the personnel of Community Homes ("Case della Comunità"). The expected € 1.18 billion expenditure is implausible to be sufficient to cover the cost for salaries of all the healthcare professionals needed, which is expected to be around € 2 billion. The National Agency for the Regional Healthcare Services (Agenzia nazionale per i servizi sanitari regionali) calculated that in Emilia-Romagna (the only region in Italy to have already implemented a healthcare structure based on the one described in the National Recovery and Resilience Plan), the activation of Community Hospitals and Community Homes reduced the rate of inappropriate access to emergency rooms by 26% (while in the National Recovery and Resilience Plan expectation is a reduction of at least by 90% for "white codes", the identified code for stable and not urgent patients). Moreover, the hypothesis for the daily cost of stay in the Community Hospital is roughly € 106, while the average current cost in the active Community Hospitals in Italy is € 132 (much higher than the National Recovery and Resilience Plan" National Recovery and Resilience Plan estimate). The underlying principle of the National Recovery and Resilience Plan is highly valuable since it strives to enhance the quality and the quantity of the healthcare services in the country that are too often left out of national investments and programs. Nevertheless, the National Recovery and Resilience Plan has critical issues due to the superficial prevision of cost. The success of the reform appears to be established by decision makers and by their long-term prospective, oriented to overcome the resistance to change.

Discrimination of elderly patients in the health care system of Lithuania

Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015). Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results: This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i) the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii) the lack of information for complaining and the fear of consequences of complaining; iii) the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv) the high level of burden of proof in court cases and lack of good practices; v) the lack of a patient (human) rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions: This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care; encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the rights of patients and compensation for the damage to their health’, clearly stating where to complain in case of discrimination; create a webpage and brochures with readable and understandable information for elderly persons and their families and caregivers; establish legal consultation and mediation cabinets in health care facilities; establish an older persons’ rights protection service under the Ministry of Social Security and Labour in close cooperation with the Ministry of Health; promote sustainable results by incorporating a human rights-based approach regarding elderly persons in all policies.

Artificial intelligence and digital medicine for integrated home care services in Italy: Opportunities and limits.

Home healthcare in the Italian health system has proven to be an essential factor in adequately responding to the health needs of an increasingly aging population. The opportunities offered by digitization and new technologies, such as artificial intelligence (AI) and robotics, are a lever for making home care services more effective and efficient on the one hand, and on the other for improving remote patient monitoring. Telemedicine devices have enormous potential for telemonitoring and telerehabilitation of patients suffering from chronic disabling diseases; in particular, AI systems can now provide very useful managerial and decision-making support in numerous clinical areas. AI combined with digitalization, could also allow for the remote monitoring of patients' health conditions. In this paper authors describe some digital and healthcare tools or system of AI, such as the Connected Care model, the Home Care Premium (HCP) project, The Resilia App and some professional service robotics. In this context, to optimize potential and concrete healthcare improvements, some limits need to be overcome: gaps in health information systems and digital tools at all levels of the Italian National Health Service, the slow dissemination of the computerized medical record, issues of digital literacy, the high cost of devices, the poor protection of data privacy. The danger of over-reliance on such systems should also be examined. Therefore the legal systems of the various countries, including Italy, should indicate clear decision-making paths for the patient.

Impact of COVID-19 on emergency department use among home care recipients

Abstract Background The impact of COVID-19 pandemic on Emergency Department (ED) was remarkable throughout Europe. We focused upon ED utilization among integrated home care (IHC) recipients comparing ED between pandemic period with pre-pandemic (February -December 2020 and 2019, respectively) in Piedmont, Italy. Methods A retrospective observational study was conducted. All recipients of IHC during the two periods studied were enrolled and all ED visits that occurred among IHC recipients were accounted for. Several variables related to IHC admission, reason of ED visits and demographic characteristics were collected. The average of ED visits in pre-pandemic and pandemic periods were calculated. Analyses were stratified by all variables. Results Patients enrolled were 11968 in 2019 and 8938 in 2020. In 2019, 3573 patients had at least one ED visit and 1668 patients in 2020. Number of ED visits was 5503 in 2019 and 2197 in 2020. The average of ED visits in 2020 has reduced in comparison with 2019 (0.464 C.I. [0.44-0.489] and 0.24 C.I. [0.227-0.252], p < 0.001 in 2019 and 2020 respectively). This reduction is regardless of sex, age, duration of IHC, presence of a non-family caregiver or reason for ED visits, except for abdominal pain, cardiac rhythm alteration and gynaecological symptoms. The averages of ED visits were significantly lower for IHC recipients with neoplasm (0.549 C.I. [0.513-0.585] and 0.328 C.I. [0.298-0.358], p < 0.001, and with low level of emergency (1.77 C.I. [1.662-1.877] and 1.397 C.I. [1.348-1.447], p < 0.036), but an increase in mortality rate was not registered. Conclusions Our results showed a reduction of ED visits among integrated home care recipients in pandemic period in comparison with pre-pandemic period. If the reduction can be the consequence of an unprepared health service that needs of necessary changes in its organization, these results suggest a great potential of the home care system to reduce the use of the hospital especially for low-risk conditions. Key messages • The COVID-19 pandemic overwhelmed health services of all European Countries. A reduced utilization of ED has been shown by literature, especially during the early phase of the COVID-19 pandemic. • We showed a reduction in IHC recipients and a great decrease in ED visits among IHC patients in 2020 versus 2019, mainly in oncological patients, while an increase in mortality rate was not reported.

USCA service utilization in the city of Florence (Italy) during the COVID-19 pandemic

Abstract Background In order to support primary care during the first pandemic wave (March 2020), the Italian Government instituted multiprofessional health teams called “USCA” (Special Continuity Care Units), which ensured continuity of care for COVID-19 patients who do not need hospitalization. The aim of our study was to compare the volumes of USCA service utilization in Florence (Tuscany, Italy) during the peak of home visits of three pandemic waves. Methods This single-center study followed a retrospective cross-sectional design. The USCA of the Heath District of Florence served a population of 366,190 people. The following data were collected: home medical visits, nursing home (NH) visits, visits in health-care hotels. The peak periods of three epidemic waves were considered in the analyses: the second wave (23 October - 20 November 2020), the third wave (25 March - 22 April 2021), and the Omicron period (27 December 2021 - 6 February 2022). The maximum 7-day moving averages of the daily number of visits during the three periods were calculated. Relative percent differences for visits comparing the considered periods were computed. Results Home visits during the third pandemic wave increased by 14% compared to the second wave (second wave: N = 1370, third wave: N = 1562), while a decrease was observed during the Omicron period (Omicron vs third wave: -21%; peak value: 41 vs 60). Visits in health-care hotels during the third wave doubled compared to the second wave. After the start of the COVID-19 vaccination campaign, NH visits steeply declined (third wave vs second wave: -95%; N = 323 vs 15; peak value= 14 vs 2 visits per day). During the Omicron period, NH visits increased by almost four times compared to the third wave period. Conclusions The USCA service utilization was significant in all the analyzed periods. In a pandemic context, it is necessary to strengthen primary care services such as USCA, which have proved to respond to rapidly changing health needs. Key messages • The USCA service is an innovative model of integrated home care that has proved to respond to rapidly changing health needs during all phases of the COVID-19 pandemic. • The USCA service utilization was significant during all phases of the pandemic. The USCA service has introduced new ways of working and new relationships between services in primary care.

Optimizing an integrated home care problem: A heuristic-based decision-support system

With the continuous increase in longevity worldwide, the elderly population requiring home health and social care has been continuously growing over the years. Planning combined home health and social services has been shown to be a very difficult task for current decision-makers, not only due to the high number of working regulations and user-related necessities that need to be considered but also due to the need for synchronizing both types of services. Moreover, it is highly desirable that users are visited by the fewest number of different caregivers in the same kind of appointments (continuity of service). The complex and multi-objective nature of the synchronized home health and social care routing and scheduling problem has called for the development of automated planning systems that are able to obtain efficient solutions in reasonable computational times. In this work, we propose two heuristic methods to optimize routing and scheduling decisions for this problem with an extensive set of constraints and objectives. We use (real) data and information from current care providers in the Barcelona area to build and test our models and provide insights into parameter tuning and the trade-off between the associated operating costs, continuity of service and number of unscheduled services. The proposed tool is made available via a web-based decision support system that allows decision-makers to obtain efficient solutions in an intuitive, complete, and timely manner.

Transforming healthcare ecosystems through blockchain: Opportunities and capabilities for business process innovation

Blockchain is an unprecedented enabler and booster of business process innovation, especially in the healthcare sector. Nonetheless, its transformational potential has yet to be fully harnessed because of the challenges that digitalization has posed to Business Process Management (BPM) and the inherent complexity of the healthcare processes. Accordingly, through the ambidextrous BPM theoretical lenses, this paper investigates what are the main opportunities for Blockchain-driven healthcare process innovation and which BPM capabilities may unleash them. Two exploratory case studies were conducted to probe the Blockchain-driven process redesign: a case of exploitative BPM, focusing on drug logistics, and a case of explorative BPM, focusing on integrated home care. Our findings suggest that Blockchain may enable Healthcare innovation opportunities, such as the redesign of the information flow and the development of new forms of collaboration in the health ecosystem. In addition, the most relevant BPM capabilities to pursue such innovations were identified. These results integrate the BPM research stream and enhance the understanding of Blockchain-driven healthcare process innovation.

Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy.

Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years. The analysis included 39 822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups. We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group. IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this.