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Introduction: The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods: We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings: 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion: Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (-37.2%) and hospital stays (-38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of -46.3%. [ABSTRACT FROM AUTHOR]

In Diagrammatic Writing (2013), Johanna Drucker discusses the power dynamics between texts interacting on a page. So-called autotheoretical texts often engage in similar types of performative and relational lay-outs, and yet, not much has been written about this formal phenomenon. Bearing this in mind, I propose an experiment that performs relations by thinking with, and through, Las Meninas, a self-portrait that is not strictly about the self. All that surrounds Velázquez in the painting (the work-in-progress we do not see, the ensemble of courtly characters, the framed reproductions of masters' works, the much-discussed mirror reflection) informs and contextualises the portrait, but also explodes it into much more. This paper thus attempts to ask whether autotheory can, by being aware of performative and diagrammatic writing, together with the use of images as citations, decentralise the auto- and become a more choral scene, a cluster, a textual quodlibet or medley. Can a form of writing make space for a multitude, or even, a multitude into a space? Can the autotheoretical self be only one more of many characters, present, with agency, but off-centred? [ABSTRACT FROM AUTHOR]

The 2020-21 pandemic threw many of us into a forced exploration of our domestic interiors. For some, the limited contact with the exterior world provoked a need for a refuge and escape: the recurrence of the interior eventually gave way to our interiorities. Looking for ways to simultaneously materialise and circumvent a spatial, intimate, and spiritual sense of self, this visual essay borrows the sumptuous patterns and textures of the interior in Kitagawa Utamaro's 1788 erotic print, Lovers in an Upstairs Room (Figure 01). These, cut-out as inspired by the block-printing process, have been layered with my own absolutely mundane, domestic setting. At the same time, two fragmentary voices, one ekphrastic and one auto-theoretical, mirror the print and the graphic layering, creating a third text by overlapping. These voices host a multiplicity of others: from the mystical classic The Interior Castle, 1577, by the sickly, cloistered, Spanish nun Teresa of Ávila, which describes an ecstatic topography of the soul; to Canadian poet Lisa Robertson's 2003 'Soft Architecture: A Manifesto,' which calls for softness as a form of resistance; and for description as a mystical practice: 'Practice description. Description is mystical. Can the crash of voices, cultures, and imagery add up to one particular description? Can this description of one's interiority at a very specific time build connections between tangible and immaterial, ordinary and extraordinary? Can there be a secular, soft topography of the self, of one's interior castle, able to resist the advances of a hostile reality? [ABSTRACT FROM AUTHOR]

Introduction Along with the Covid-19 pandemic, the social and health systems faced a great challenge, particularly in institutionalized patients. An integrated care emergency response was required, not only for the Covid-19 impact on health outcomes but for the complexity of the pandemic control in long term care facilities (LTCF). Due to a lack of evidence on how to respond to new pandemic disease, we created a multidisciplinary group from a network of public primary care teams (PCT), to set up and unify the implementation of the strategic lines in management of the Covid-19 emergency in LTCF. All decisions were taken under expert's consensus and they were implemented by a learning-by-doing method, based on protocols, IT solutions expressly implementation, and strategies shared with local health and social authorities. Aim The aim was to set up and unify the implementation of the strategic lines in Covid-19 prevention, diagnostic and clinical management along with all LTCF of our area. We were urged to develop different clinical protocols to deliver patient-centred care tailored to the needs derived from the different stages of the emergency. Targeted population 10,688 residents from 196 LTCF (169 nursing homes and 27 institutions for people with physical and mental disabilities). A network of public and private stakeholders collaborated to implement multilevel strategies supported by the Government of Catalonia. Timeline Started in March 2020. We defined three phases. First wave: March to June (developing and setting up strategic lines); Off-peak (between waves): June to October (strengthening disease control prevention); Second wave: October until December 2020 (applying all lessons learned along the process). Highlights 64 PCT led the response to guarantee 24 hours seven days a week care. Massive testing to residents and workers was introduced. New IT implemented solutions were: coVIDApp (to improve daily communication with LTCF staff, by sharing information on disease control and patient's needs) and Covid-19 LTCF intranet business object platform (for clinical and epidemiological indicators follow-up). We developed a necessary basic conditions checklist of measures on LTCF pandemic preparedness for Covid-19 prevention. An improvement in infection control and mortality was detected between phases. Comments on sustainability High sustainability due to no new structures were created and a pragmatic approach reached. Comments on transferability High transferability due to the possibility of post-pandemic continuation of this collaborative networking, to build more integrated care in LTCF. Conclusions a. The more efficient strategy to reduce mortality was infection prevention. b. Using tests regularly for both residents and workers was key to detect all infected but asymptomatic patients. c. Defining risk factors for poor bad epidemiologic disease control at the facility level led to early preventive actions. Discussions All stakeholders assumed a unique strategy with shared objectives. Outbreak prevention, by detecting LTCF risks and avoiding spreading was key. An end-of-life focus emerged as a need, to provide right time right care palliative care to individuals with advanced illness and advanced care plans in this sense. Lessons learned This emergency response was an opportunity for re-thinking future integrated care LTCF approaches provided by several stakeholders. [ABSTRACT FROM AUTHOR]

BackgroundThe coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. ObjectiveThe aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. MethodsCOVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase–polymerase chain reaction; absence of symptoms for ≥14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. ResultsData were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for ≥14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). ConclusionsCOVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies.

Introduction: The growing numbers of People with Complex Chronic Conditions (PCCC) has been leading to a challenge of adaptation of the care providers' response to the high needs presented by individuals. Short description of practice change implemented: The creation of a Chronic Care Management Team (CCMT) supported an innovative strategy focused on reaching a more integrated model of care. A community-based care programme was developed based on: a. International evidence (reviewed by two CCMT experts); b. A consensus reached by clinical leaders involved on care (in a local task force group with 60 members from primary and secondary care); c. The inclusion of people experience (by two focus groups with patients, and home interviews to carers and members of community institutions). It led to a new organisational and governance model for the whole territory. An IT tools adaptation was required to support the CCMT task on monitoring the care process and outcome indicators. Aim and theory of change: In order to improve the quality of the care process and to obtain patientcentred outcomes in an efficient way, it was urged to change the usual model, to a new multidisciplinary, multidimensional, patient-centred provision of integrated care focused in the community, with the central role of expert Primary Care teams. Targeted population and stakeholders: PCCC including those with advanced illnesses. Stakeholders: several units from the Catalan Health Institute in Badalona area, North of Barcelona, as a territorial public provider of primary care and hospital care, which collaborate with other social care and intermediate care providers in the area. Timeline: Phase 1: development of theory for change (2018); Phase 2: implementation of the new model of care (2018-2019); Phase 3: evaluation of the model (2019). Highlights (innovation, Impact and outcomes) People-centred integrated care ongoing project at meso level as a response to high needs of PCCC in an urban territory in the Catalan public health system. Definition of the care model by people involved on care (patients, carers and staff). Functional integration of clinicians from the institution. CCMT led the integration by: defining and monitoring the quality of the care process, planning the adaptation of resources, and evaluating people-centred outcomes. Comments on sustainability: High sustainability expected due to the pragmatic approach. Comments on transferability: High transferability expected due to the position of our institution in the health system. Conclusions (comprising key findings): Our project was created based on a need to deepen on integrated care provision. Preliminary results on the quality of the care process have been evaluated. Preliminary results centred on people have been evaluated. Discussion: It is a huge opportunity for our system to develop and evaluate an integrated care strategy at a meso level, following the Catalan Government integrated care strategy. Lessons learned: Adapting the theoretical model to real world required a strong leadership, clear governance, time for change and the alignment of all the actors. The consensus reached, based on people experience and views, was a strong element for change. [ABSTRACT FROM AUTHOR]