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Introduction Reducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic obstructive respiratory disorders and comorbidities are explainable by multifactorial but actionable factors.The current protocol (January 2024–December 2025) relies on the hypothesis that intertwined actions in four dimensions: (1) management change, (2) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, (3) mature digital support and (4) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies. Accordingly, the main objective is to implement a novel integrated care preventive service for enhanced management of these patients, as well as to evaluate its potential for value generation.Methods and analysis At the end of 2024, the specifics of the novel service will be defined through the articulation of its four main components: (1) enhanced lung function testing through oscillometry, (2) continuous monitoring of indoor air quality as a potential triggering factor, (3) digital support with an adaptive case management (ACM) approach and (4) predictive modelling for early identification and management of exacerbations. During 2025, the novel service will be assessed using a Quintuple Aim approach. Moreover, the Consolidated Framework for Implementation Research will be applied to assess the implementation. The service components will be articulated through four sequential 6-month plan-do-study-act cycles. Each cycle involves a targeted cocreation process following a mixed-methods approach with the active participation of patients, health professionals, managers and digital experts.Ethics and dissemination The Ethics Committee for Human Research at Hospital Clinic de Barcelona approved the protocol on 29 June 2023 (HCB/2023/0126). Before any procedure, all patients in the study must sign an informed consent form.Trial registration number NCT06421402.

Abstract Background Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). Methods A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017–2018, was carried out with a health system perspective. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. Results HaH-HA and Controls (n = 441 each) were comparable in terms of age (73 [SD16] vs. 74 [SD16]), gender (male, 57% vs. 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p

Background Computer-assisted interpretation of single-lead ECG is the preliminary method for clinicians to flag and further evaluate an arrhythmia of clinical importance for acutely ill patients. Critical scrutiny of novel detection algorithms is lacking, particularly in external real-world data sets. This study’s objective was to evaluate a hybrid machine learning model’s ability to classify eight arrhythmias from a single-lead ECG signal from acutely ill patients.Methods This cross-sectional external retrospective evaluation of a previously trained hybrid machine learning model against an ECG reading team in the setting of home hospital care (acute care delivered at home substituting for traditional hospital care) draws from patients admitted at two hospitals in Boston, Massachusetts, USA between 12 June 2017 and 23 November 2019. We calculated classifier statistics for each arrhythmia, all arrhythmias and strips where the model identified normal sinus rhythm.Results The model analysed 2 680 162 min of single-lead ECG data from 423 patients and identified 691 478 arrhythmias. Patients had a mean age of 70 years (SD, 18), 60% were female and 45% were white. For any arrhythmia, the model had a sensitivity of 98%, a specificity of 100%, an accuracy of 98%, a positive predictive value of 100%, a negative predictive value of 93% and an F1 Score of 99%. Performance was best for pause (F1 Score, 99%) and worst for paroxysmal supraventricular tachycardia (F1 Score, 92%). The model’s false positive rate for any arrhythmia was 0.2%, ranging from 0.4% for pause to 7.2% for paroxysmal supraventricular tachycardia. The false negative rate for any arrhythmia was 1.9%.Conclusions A hybrid machine learning model was effective at classifying common cardiac arrhythmias from a single-lead ECG in real-world data.

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

Abstract Background Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016–2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011–2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). Methods The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. Discussion The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection. Trials registration NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).

Objectives: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus.Setting: One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388).Method: The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted.Results: The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites.Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

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.

Introduction: Complex chronic patients are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a qualitative analysis performed into the EU initiative JADECARE (2020–2023) to design a digitally enabled integrated care program aiming at preventing unplanned hospitalizations. Methods: A two-phase process with four design thinking (DT) sessions was conducted to analyse the management of complex chronic patients in the region of Catalonia (ES). In Phase I, Discovery, two DT sessions, October 2021 and February 2022, were done using as background information: i) the results of twenty structured interviews (five patients and fifteen professionals), ii) two governmental documents on regional deployment of integrated care and on the Catalan digital health strategy, respectively, and iii) the results of a cluster analysis of 761 hospitalizations. In Phase II, Confirmation, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two additional DT sessions conducted in November and December 2022. Discussion: The qualitative analysis identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during the period 2024–2025, was generated. Conclusions: A digitally enabled adaptive case management approach to foster collaborative work and personalization of care, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations. Resum Introducció: Els pacients crònics complexos són propensos a hospitalitzacions no planificades que comporten una gran càrrega per els sistemes sanitaris arreu del mon. Les intervencions per prevenir ingressos no planificats mostren resultats poc concloents pel que fa a efectivitat. Aquest estudi descriu una anàlisi qualitativa realitzada, en el marc de l’Acció Conjunta Europea JADECARE (2020–2023), per dissenyar un programa d’atenció integrada, amb suport digital, que te per objectiu prevenir les hospitalitzacions no planificades. Mètodes: L’estudi va consistir en un procés de co-disseny efectuat a partir de l’anàlisi de la gestió de pacients crònics complexos en la demarcació de Catalunya (ES). Es va efectuar en dues fases amb un total de quatre sessions de “Design Thinking (DT)”. A la Fase I, Discovery, es van fer dues sessions de DT, Octubre de 2021 i Febrer de 2022, utilitzant com a informació de fons: i) Els resultats de vint entrevistes estructurades (cinc pacients i quinze professionals), ii) Dos documents governamentals sobre el desplegament regional de l’atenció integrada i sobre l’estratègia de salut digital, respectivament, i iii) Els resultats d’una anàlisi de clústers de 761 hospitalitzacions. A la Fase II, Confirmació, vam examinar els resultats als 30 i 90 dies post-alta hospitalària de 49.604 casos en a dues sessions de DT addicionals realitzades durant els mesos de Novembre i Desembre de 2022. Discussió: L’anàlisi qualitativa va identificar: i) Insuficient personalització de les intervencions, ii) Necessitat de canvis organitzatius, iii) Immaduresa de la digitalització, i iv) Avaluació sub-óptima del desplegament dels serveis com a principals factors explicatius de la bretxa entre eficàcia i efectivitat observada en estudis previs. L’estudi proposa un programa de prevenció d’hospitalitzacions no planificades, a avaluar durant el període 2024–2025. Conclusions: Els resultats de l’anàlisi qualitativa donen suport a la modalitat de gestió adaptativa de casos, amb suport digital, per fomentar el treball col·laboratiu i la personalització de l’atenció. També plantegen la necessitat de reenginyeria dels processos clínics per assolir una prevenció eficient i basada en valors, de les hospitalitzacions no planificades en el mon real. Paraules Clau: Gestió adaptativa de casos; “Design Thinking”; Digitalització; Atenció personalitzada; Prevenció d’ingressos hospitalaris no planificats

RESUMEN La dehiscencia de la sutura de la herida quirúrgica por causas infecciosas es una de las complicaciones que aumenta los costes de la estancia hospitalaria. La terapia de presión negativa (TPN) se utiliza para la cura de heridas complejas. Objetivo: mostrar la eficacia de la TPN en una herida abdominal cavitada, mediante la descripción de un caso clínico, tratada en el Dispositivo Transversal de Hospitalización a Domicilio (HAD) del Hospital Clínic de Barcelona. Metodología: Descripción de las características de la herida, realización del plan de cuidados, tratamiento y la evolución durante el ingreso en HAD. Resultados: Este trabajo muestra los efectos beneficiosos del dispositivo de HAD respecto al tratamiento de heridas con TPN. Conclusiones: Se muestra la necesidad de la realización de estudios, no solo casos clínicos, para generar evidencia científica de la TPN en el ámbito de HAD.

Introduction: The present study aimed to assess the effectiveness of the current hospital-based electronic patient safety incident reporting system (IRS) in the improvement of patient safety in home hospitalization (HH). Materials and Methods: Out of 6381 patient safety reports voluntarily presented by healthcare professionals in a tertiary hospital in Barcelona between 2016 and 2019, all those related to HH were analyzed. They were characterized by incident type, description, risk and year, the ways to get notified, patient’s age, and the results of the analysis. Moreover, falls were classified depending on circumstances. Results: Based on the results, 68 HH incident reports were related to the following factors: use of medication (n=2), procedures (1), patient’s behavior (n=1), and falls (n=64). Regarding the damage degree, the incidents were reported as extreme risk (n=1), high (n=8), moderate (n=27), low (29), and very low risk (n=3). The majority of patients involved in the incidents were more than 60 years old. Out of the reported falls, 8 cases were categorized as high risk, and 32 cases reported health consequences. Moreover, 19 falls from height, 31 cases of falling while sitting or lying, and 30 incidents classified as unknown were identified. Conclusion: Patient safety is a matter of great concern, especially in HH but with some differential features. The IRS can play a peculiar role in minimizing patient safety risks and promoting a safety culture. The results of the present study pointed to some frequent risks and suggested improving opportunities in HH. Nonetheless, further studies are needed to design tailored patient safety interventions in HH, as well as a tailored IRS adapted to this growing setting.

Objetivo: Explorar si una formación sobre estrategias de identificación y evaluación de información sanitaria en línea tiene un impacto positivo en la percepción de los/las estudiantes sobre sus propias competencias informacionales en e-salud. Métodos: Se administró el cuestionario validado eHEALS a una muestra de estudiantes de bachillerato, de entre 15 y 18 años de edad. Una semana después asistieron a una sesión de formación sobre cómo buscar e identificar información y fuentes sanitarias fiables en Internet. Al final de la sesión respondieron nuevamente el cuestionario eHEALS. En ambas sesiones se registró información sobre el sexo y el curso de los participantes. Se evaluaron las competencias percibidas en e-salud antes de la formación y se compararon con las obtenidas después. Se llevaron a cabo regresiones bivariadas y múltiples. Resultados: De 298 estudiantes cursando Bachillerato, 285 fueron incluidos/as en el estudio. El 52,28% (149) eran mujeres y el 47,72% (136) eran hombres. La media del resultado del cuestionario eHEALS antes de la intervención fue de 24,19 (rango: 8-40), y después fue de 28,54. La exposición a la formación estaba asociada con un incremento de los resultados de las competencias informacionales percibidas en e-salud (p

Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored. Objective: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. Methods: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients’ and professionals’ perspectives, technologies and costs were evaluated. Results: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0–3) days and the length of home-based stay was 6 (5–7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. Conclusions: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.

This article present the project developed in 2011 by units and training centers from all public universities in Catalonia. The project is devised towards the quality improvement of the higher education system and of the activity undertaken by the faculty at the university. In order to achieve these objectives, it focuses on the identification of teaching skills, defined by the academic community through training programs specifically designed for this purpose. Taking the implementation of the European Higher Education as starting point, the project intends to analyze the skills considered to belong by nature to the teaching task, as well as to define the necessary procedures to acquire, develop and evaluate them through training. At the same time it seeks to identify models, strategies, tools and resources. To this identification process we will make the necessary bibliographical research, in which the criteria of teaching excellence will allow us to select a representative sample of teachers. The selection will be performed through a survey and its quality will be validated by experts. The primary objective of the project shown here is basically to contribute to the quality training of university teachers, allowing the acquisition, development and evaluation of the skills considered essential by the academic community, in order to properly undertake their professional tasks, defined as: interpersonal, methodology, communication, planning and management of teaching, teamwork and innovation.

Este artículo presenta el proyecto desarrollado durante el año 2011 por las unidades y centros de formación de las universidades públicas catalanas. El proyecto se orienta a la mejora de la calidad del sistema de educación superior y de la actividad del profesorado universitario mediante planes de formación específicamente diseñados con esta finalidad, centrándose primeramente en la identificación de competencias docentes definidas por la comunidad académica. Partiendo del contexto de implementación del Espacio Europeo de Educación Superior se identifican aquellas competencias propias de la función docente, para que posteriormente puedan ser adquiridas, desarrolladas y evaluadas mediante la formación, identificando modelos, estrategias, instrumentos y recursos que lo permitan. El proceso de identificación de las competencias docentes del profesorado universitario se ha desarrollado partiendo de una revisión bibliográfica del estado del arte, para posteriormente ser modificada y validada por grupos de discusión conformados por expertos en competencias y formación docente. Los resultados de identificación de dichas competencias han sido finalmente refrendados mediante una encuesta respondida por una muestra representativa de la comunidad académica de las ocho universidades públicas catalanas. El objetivo fundamental del proyecto que aquí presentamos no es otro que el de contribuir a una formación de calidad del profesorado universitario, que permita la adquisición, desarrollo y evaluación de las competencias que, como docente, gran parte de la comunidad académica considera que debe poseer para el ejercicio de su labor profesional, definidas como: interpersonal, metodológica, comunicativa, de planificación y gestión de la docencia, de trabajo en equipo y de innovación. ABSTRACTIdentification of teaching skills in the implementation of training plans for university teaching staff.This article present the project developed in 2011 by units and training centers from all public universities in Catalonia. The project is devised towards the quality improvement of the higher education system and of the activity undertaken by the faculty at the university. In order to achieve these objectives, it focuses on the identification of teaching skills, defined by the academic community through training programs specifically designed for this purpose. Taking the implementation of the European Higher Education as starting point, the project intends to analyze the skills considered to belong by nature to the teaching task, as well as to define the necessary procedures to acquire, develop and evaluate them through training. At the same time it seeks to identify models, strategies, tools and resources. To this identification process we will make the necessary bibliographical research, in which the criteria of teaching excellence will allow us to select a representative sample of teachers. The selection will be performed through a survey and its quality will be validated by experts. Th e primary objective of the project shown here is basically to contribute to the quality training of university teachers, allowing the acquisition, development and evaluation of the skills considered essential by the academic community, in order to properly undertake their professional tasks, defined as: interpersonal, methodology, communication, planning and management of teaching, teamwork and innovation.

Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge.A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed.We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003).The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP.Controlled-Trials.com ISRCTN39531840.