Integrated care services: lessons learned from the deployment of the NEXES project

Area of Science:

• Health Services Research
• Digital Health
• Chronic Disease Management

Background:

• Integrated care services (ICS) supported by information technology (IT) are crucial for managing chronic conditions.
• Deployment challenges for IT-enabled ICS need to be understood across diverse European healthcare settings.

Purpose of the Study:

• To identify barriers and facilitators in deploying four distinct IT-supported ICS across three European sites.
• To evaluate the impact of these services on patients with chronic obstructive pulmonary disease, cardiac failure, and type II diabetes mellitus.

Main Methods:

• Study conducted in Spain (n=11,382), Norway (n=450), and Greece (n=388) across four ICS: home-based rehabilitation maintenance, enhanced care for frail patients, home hospitalization/early discharge, and remote diagnostic support.
• Employed a combination of randomized controlled trials and pragmatic study designs, adopting the Model for Assessment of Telemedicine applications.
• Compared two distinct technological approaches to service delivery.

Main Results:

• Demonstrated sustainability of training effects for chronic obstructive pulmonary disease patients (p < 0.01).
• Showed enhanced care and reduced hospitalizations for chronic respiratory patients (p < 0.05).
• Achieved significant reductions in in-hospital days (p < 0.001) and improved testing quality (p < 0.01) in specific service implementations, with site variations noted.

Conclusions:

• The four IT-supported ICS exhibit significant potential for improving health outcomes and achieving cost containment.
• Key factors influencing successful deployment include change management, technological integration, and legal considerations.
• A business plan was developed to promote sustainability and innovation, emphasizing the need for site-specific deployment strategies.