Roca, Josep

Abstract:

Facing the challenge of the new healthcare landscape
Integrated care and information technologies

The rapidly shifting balance between acute and chronic care problems is placing new and different demands on health care systems worldwide. In economically developed countries, infectious diseases still played a central role during the first half of the twentieth century. Since the end of World War II, episodic care of acute medical and surgical conditions has strongly modulated healthcare organizations. In the late 90's, however, different studies [1] warned on the emerging healthcare needs triggered by the increased prevalence of chronic conditions in ageing populations.

The conceptual aspects of planned care for chronic patients were originally formulated by Wagner EH et al [2] and subsequently adopted by the World Health Organization (WHO) [3]. It is of note, however, that crossing the current gap in healthcare will become a lengthy and complex process toward a truly patient-centred approach. Ultimately, encouragement of preventive strategies promoting behavioural changes in life-style and the design of innovative home-based services must become main components of integrated care strategies within regional networks aiming at a progressive deployment of the Chronic Care Model [2, 3]. In building up such strategies, the establishment of effective functional relationships among providers, regardless of their ownership or position in the care chain, will preclude the current fragmentation of services across levels of care. Activities included in integrated interventions, such as sharing information or agreed-on care plans, can not be easily made operative in the absence of a robust support of information and communication technologies (ICT). In this scenario, there is general consensus that the skills of health professionals must be expanded to meet the new complexities [4].

In 2000, the Integrated Care Program for Chronic Patients (ICCP) was conceived as a key component of the restructuring process of one of the tertiary hospitals of the city of Barcelona (Hospital Clínic). The ICCP was initially conceived as a pilot transversal unit (Integrated Care Unit) across the different clinical institutes of the hospital. One of its pivotal aims was to promote bridging between hospital and primary care services through a continuum of care supported by a web-based ICT platform.

Core activities of the ICCP are:
- Validation of innovative home-based healthcare services
- Support of interactions among professionals across the healthcare system
- Facilitation of accessibility of target patient groups and their caregivers

Until the end of 2003, the ICCP was developed as a set of disease-specific pilots essentially addressed to cover chronic respiratory patients, from early COPD stages to those with end-stage disease. The most prominent benefits during the period have been the development of
- Collaborative tools to support the extensive use of high quality forced spirometry in primary care
- Home hospitalization and early-discharge program
- Prevention strategies to avoid unnecessary hospitalizations due to episodes of acute exacerbation
- Strategies for end-stage disease

The results obtained in the trials will be presented in the conference [5-8]. Since 2004, the ICCP has been consolidated and its services are currently being expanded to other areas of the region and to programs addressed to patients with multiple co-morbid conditions (chronic heart failure, diabetes, COPD, AIDS). Moreover, the ICT platform has experienced continuous developments mainly based on mobile technologies.

The Catalan Health Administration has supported the ICCP initiative since its initial implementation. Successful achievements of ICCP have been improvement of clinical outcomes, enhancement of both patient's self-management and health-related quality of life, together with significant cost containment and improvement of the interactions among levels of care.