Abstract
Objectives: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in
three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with
obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus.
Setting: One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital
in Greece (Athens) (n = 388).
Method: The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail
patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry
testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological
approaches were compared. The Model for Assessment of Telemedicine applications was adopted.
Results: The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease
(p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all
types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with
respiratory symptoms in Support, with marked differences among sites.
Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change
management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated
a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.
three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with
obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus.
Setting: One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital
in Greece (Athens) (n = 388).
Method: The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail
patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry
testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological
approaches were compared. The Model for Assessment of Telemedicine applications was adopted.
Results: The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease
(p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all
types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with
respiratory symptoms in Support, with marked differences among sites.
Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change
management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated
a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.
