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Abstract Background Hospital at home (HaH) was increasingly implemented in Catalonia (7.7 M citizens, Spain) achieving regional adoption within the 2011-2015 Health Plan. This study aimed to assess population-wide HaH outcomes over five years (2015-2019) in a consolidated regional program and provide context-independent recommendations for continuous quality improvement of the service. Methods A mixed-methods approach was adopted, combining population-based retrospective analyses of registry information with qualitative research. HaH (admission avoidance modality) was compared with a conventional hospitalization group using propensity score matching techniques. We evaluated the 12-month period before the admission, the hospitalization, and use of healthcare resources at 30 days after discharge. A panel of experts discussed the results and provided recommendations for monitoring HaH services. Results The adoption of HaH steadily increased from 5,185 episodes/year in 2015 to 8,086 episodes/year in 2019 (total episodes 31,901; mean age 73 (SD 17) years; 79% high-risk patients. Mortality rates were similar between HaH and conventional hospitalization within the episode [76 (0.31%) vs. 112 (0.45%)] and at 30-days after discharge [973(3.94%) vs. 1112(3.24%)]. Likewise, the rates of hospital re-admissions at 30 days after discharge were also similar between groups: 2,00 (8.08%) vs. 1,63 (6.58%)] or ER visits [4,11 (16.62%) vs. 3,97 (16.03%). The 27 hospitals assessed showed high variability in patients’ age, multimorbidity, severity of episodes, recurrences, and length of stay of HaH episodes. Recommendations aiming at enhancing service delivery were produced. Conclusions Besides confirming safety and value generation of HaH for selected patients, we found that this service is delivered in a case-mix of different scenarios, encouraging hospital-profiled monitoring of the service.

Abstract Background Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. Objective This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. Methods a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model’s sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. Results The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. Conclusion It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.

Background: Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. Objective: This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. Methods: a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model's sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. Results: The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. Conclusion: It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries. [ABSTRACT FROM AUTHOR]

Abstract Background Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures. Methods Focus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset. Results Two focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation; role clarity; relationships; and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW. Conclusions The findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities.

Background: Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures.Methods: Focus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset.Results: Two focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation; role clarity; relationships; and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW.Conclusions: The findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities. [ABSTRACT FROM AUTHOR]

Abstract Background Preventive care has gained increasing attention in health reforms around the world due to its ability to reduce the burden of disease and to save health costs. Nevertheless, there is a gap in terms of the development of reliable systems to measure and evaluate performance of preventive care in order to support decision-making and increase service outcomes. The aim of this study is to define a methodology for designing a performance management system (PMS) in order to effectively support the planning, control and evaluation of preventive care and to identify the factors that influence such a process. Methods The methodology is based on the participatory action research approach, which implies collaboration between researchers and practitioners. The study was articulated in four phases and carried out in an Italian regional healthcare system that was undergoing a major reorganization process. Results The findings provide insights into the peculiarities that affect preventive care and highlight two categories of critical factors: general issues regarding the process and specific issues regarding preventive care. The first category includes the importance of interactions between academics, physicians and policy-makers, the impact of workloads and red tape on employee involvement and the increased conservation mechanisms during periods of institutional change. The second category concerns the strong heterogeneity of preventive activities within health organizations, the huge amount of regulations and the incompleteness of information systems. Conclusion The development of a PMS for preventive care can best be served by collaborative methods that involve academics, professionals and policy-makers, whose roles and responsibilities must be clearly defined, and by an improvement in transparency and communication within organizations in order to enhance the involvement of different professionals at appropriate times and in appropriate ways. Key recommendations that may improve the maintenance and use of information systems are proposed to policy-makers.

Background: Preventive care has gained increasing attention in health reforms around the world due to its ability to reduce the burden of disease and to save health costs. Nevertheless, there is a gap in terms of the development of reliable systems to measure and evaluate performance of preventive care in order to support decision-making and increase service outcomes. The aim of this study is to define a methodology for designing a performance management system (PMS) in order to effectively support the planning, control and evaluation of preventive care and to identify the factors that influence such a process.Methods: The methodology is based on the participatory action research approach, which implies collaboration between researchers and practitioners. The study was articulated in four phases and carried out in an Italian regional healthcare system that was undergoing a major reorganization process.Results: The findings provide insights into the peculiarities that affect preventive care and highlight two categories of critical factors: general issues regarding the process and specific issues regarding preventive care. The first category includes the importance of interactions between academics, physicians and policy-makers, the impact of workloads and red tape on employee involvement and the increased conservation mechanisms during periods of institutional change. The second category concerns the strong heterogeneity of preventive activities within health organizations, the huge amount of regulations and the incompleteness of information systems.Conclusion: The development of a PMS for preventive care can best be served by collaborative methods that involve academics, professionals and policy-makers, whose roles and responsibilities must be clearly defined, and by an improvement in transparency and communication within organizations in order to enhance the involvement of different professionals at appropriate times and in appropriate ways. Key recommendations that may improve the maintenance and use of information systems are proposed to policy-makers. [ABSTRACT FROM AUTHOR]