Lesson learned from the comparative analysis of the Service Models for a large set of technology-enhanced integrated care initiatives

Abstract

Introduction: We analyzed the Service Models of 30 integrated care initiatives, through a systematic comparison of their Service Components and the related technological opportunities. Description: Twenty initiatives (13 full-scale Programmes and 7 pilots in EU-funded projects) belong to a sequence deployed in Badalona (Catalonia, Spain), where the joint health and social care delivery is active since year 2000. They were evolving over time to meet an increasingly extended range of integration needs between 2003 and 2015, when a pervasive, persistent ecosystem on Integrated Care was achieved. They are individually described in published papers; however, a systematic interpretation to highlight the major features of the journey was not yet available [1]. An additional set of ten initiatives comes from pilot activities performed in various EU-funded Projects. We used the toolkit named ""Service Deployment Outline"" (SDO) [2], a format to guide an expert having an active role in an initiative to perform a subjective but disciplined exploration of the Service Components of the related Service Model. Discussion: We interpreted the transformation processes carried, with the underlying vision and design strategies, according to various perspectives, such as: the evolution of the Service Components that addressed the most challenging integration needs; the roles of the technologies in the evolutionary processes; the factors influencing the adoption of the initiatives. Lessons learned and limitations: We worked out a number of factors influencing the propagation speed for different Service Models [3]: they marginally affect the spontaneous penetration of technology-oriented initiatives, slow down the spread of those with a clinical connotation, and severely limit the adoption of those with a strong organizational attitude. Most initiatives were labelled as ""Basic"": they are scalable, replicable, measurable, yielding a high Value and thus set up the foundations for a widespread ecosystem in a Region. They belong to three classes: - long-term follow-up of complex chronic conditions: - long-term follow-up of frailty and mobility impairment; - short-term follow-up after a severe health-related event. Other initiatives are ""Complementary"", i.e. they address narrow topics or they build on the Basic ones, eg. remote follow-up of implanted cardiac devices or treatment of depression. The unavoidable peculiarities of the context in any jurisdiction in a given period make it impossible to directly generalize our results; nevertheless, this study could facilitate a similar analysis in other localities. Conclusions: Similar studies, replicated to design or assess Roadmaps in other jurisdictions, could bring to a better understanding of: - the actual deployment of innovation processes on integrated care; - the priorities for service transformations; - the relations between integration needs, service components and technologies. [ABSTRACT FROM AUTHOR]