Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case

• Published in: BMC health services research Vol. 22; no. 1; pp. 1 - 1133
• Main Authors: Herranz, Carme, González-Colom, Rubèn, Baltaxe, Erik, Seijas, Nuria, Asenjo, Maria, Hoedemakers, Maaike, Nicolas, David, Coloma, Emmanuel, Fernandez, Joaquim, Vela, Emili, Cano, Isaac, Mölken, Maureen Rutten-van, Roca, Josep, Hernandez, Carme
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 07-09-2022; BioMed Central; BMC
• Subjects: Chronic care; Clinical outcomes; Cohort analysis; Continuity of care; Costs; Evaluation; Health Delivery Assessment; Health services; Health Services Research; Home care; Home health care; Horizontal integration; Hospital at Home; Hospitalization; Hospitals; Implementation Science; Integrated delivery systems; Intervention; Medical care; Methods; Monte Carlo simulation; Multiple Criteria Decision Analysis; Patients; Population; Primary care; Quality management; Questionnaires; Statistical analysis; Variables; Spain
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08496-z

Abstract
Background
Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain).
Methods
Prospective cohort study over one year period, 2017–2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data.
Results
HaH-HA depicted lower: i) Emergency Room Department (ER) visits (
p
 < .001), ii) Unplanned re-admissions (
p
 = .012); and iii) costs (
p
 < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (
p
 < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified.
Conclusions
We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care.
Registration
ClinicalTrials.gov (26/04/2017; NCT03130283).