Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 4, 2020
Date Accepted: Oct 29, 2020
Implementing mHealth-enabled Integrated Care for Complex Chronic Patients: an intervention effectiveness and cost-effectiveness study
ABSTRACT
Background:
Integrated care (IC) can generate health and social care efficiencies through defragmentation of care and adoption of patient-centred preventive models. eHealth can be a key enabling technology for IC.
Objective:
To assess the effectiveness and cost-effectiveness of the implementation of a mHealth-enabled IC model for complex chronic patients.
Methods:
As part of the CONNECARE Horizon 2020 project a prospective, pragmatic, two-arm, parallel, implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elder chronic obstructive pulmonary disease or heart failure patients and their carers experienced the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting on a patients’ self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status (SF-12); unplanned visits and admissions during a 6-month follow-up; and, the incremental cost-effectiveness ratio (ICER).
Results:
48 patients in the IC arm and 28 usual care controls were included (mean (SD) age 82 (7) years, mean (SD) Charlson index 7 (2)). IC patients had a significant increase in SF-12 Physical domain (mean (SD) change: +3.7 (8.4); P=0.004) and total SF-12 score (mean (SD) change: +5.8 (12.8); P=0.003), but the differences in differences between groups were not statistically significant. IC patients had 57% less unplanned visits (P=0.004) and 50% less hospital admissions related to their main chronic diseases (P=0.316). The IC program generated savings in different costs’ scenarios and ICER demonstrated cost-effectiveness.
Conclusions:
The implementation of a patient-centred mHealth-enabled IC model empowering the patient and connecting primary, hospital and social care professionals, reduced unplanned contacts with the health system and health costs, and was cost-effective. This supports the notion of system-wide cross-organisational care pathways supported by mHealth as a successful way to implement IC.
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