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. 2020 Oct 6;8(10):e20938.
doi: 10.2196/20938.

BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments

Jordi Piera-Jiménez  1   2 , Signe Daugbjerg  3 , Panagiotis Stafylas  4 , Ingo Meyer  5 , Sonja Müller  6 , Leo Lewis  7 , Paolo da Col  8 , Frans Folkvord  1   9 , Francisco Lupiáñez-Villanueva  1   10
Affiliations

BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments

Jordi Piera-Jiménez et al. JMIR Med Inform. .

Abstract

Background: Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce.

Objective: The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain.

Methods: A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology-enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months.

Results: The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI -4.51 to 4.78; P=.95) but decreased in the comparator group (mean change -3.23, 95% CI -5.34 to -1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of -0.23 (95% CI -0.44 to -0.02; P=.03) and -0.33 (95% CI -0.46 to -0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI -0.44 to 1.01, P=.44; comparator: mean change -0.29, 95% CI -0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582).

Conclusions: The information and communication technology-enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved.

Trial registration: ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004.

Keywords: chronic disease; clinical effectiveness; cost-effectiveness; digital health; integrated care; telecare; telemedicine.

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Conflict of interest statement

Conflicts of Interest: The authors declare no conflicts of interest. The BeyondSilos team received 50% funding for Research and Innovation from the European Union for the project. The provider of the telehealth solution (Health Insight Solutions) is a privately-owned company which was not part of the project and was subcontracted under a public tendering process by BSA.

Figures

Figure 1
Figure 1
3-state Markov model applied for the BeyondSilos cost-effectiveness analysis.
Figure 2
Figure 2
Flowchart of participant recruitment for the BeyondSilos project.
Figure 3
Figure 3
Cost-effectiveness plane for a willingness-to-pay of €15,000 (approximately US $17,481)/quality-adjusted life year. ICER: incremental cost-effectiveness ratio; QALY: quality-adjusted life year; WTP: willingness-to-pay.
Figure 4
Figure 4
Sensitivity analysis showing effects between 0% and 5% change in utilities—willingness-to-pay of €15,000 (approximately US $17,481)/quality-adjusted life year. QALY: quality-adjusted life year; WTP: willingness-to-pay.
Figure 5
Figure 5
Sensitivity analysis showing effects between 0% and 5% change in costs—willingness-to-pay of €15,000 (approximately US $17,481)/quality-adjusted life year. QALY: quality-adjusted life year; WTP: willingness-to-pay.
See this image and copyright information in PMC

References

    1. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002 Feb 27;287(8):1022–8. doi: 10.1001/jama.287.8.1022. - DOI - PubMed
    1. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc. 2004 Sep;52(9):1417–23. doi: 10.1111/j.1532-5415.2004.52401.x. - DOI - PubMed
    1. Dainty KN, Golden BR, Hannam R, Webster F, Browne G, Mittmann N, Stern A, Zwarenstein M. A realist evaluation of value-based care delivery in home care: The influence of actors, autonomy and accountability. Soc Sci Med. 2018 Jun;206:100–109. doi: 10.1016/j.socscimed.2018.04.006. - DOI - PubMed
    1. Mogensen CB, Ankersen ES, Lindberg MJ, Hansen SL, Solgaard J, Therkildsen P, Skjøt-Arkil Helene. Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness. Scand J Trauma Resusc Emerg Med. 2018 Apr 05;26(1):26. doi: 10.1186/s13049-018-0492-3. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-018-0492-3 - DOI - DOI - PMC - PubMed
    1. Leichsenring K. Developing integrated health and social care services for older persons in Europe. Int J Integr Care. 2004 Sep 03;4(3):e10. doi: 10.5334/ijic.107. http://europepmc.org/abstract/MED/16773149 - DOI - PMC - PubMed

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