Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort

Author:

Vela EmiliORCID,Plaza Aina,Carot-Sans GerardORCID,Contel Joan C.,Salvat-Plana Mercè,Fabà Marta,Giralt Andrea,Ribera Aida,Santaeugènia Sebastià,Piera-Jiménez JordiORCID,

Abstract

AbstractPurposeTo assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration.DesignThe health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data.FindingsThe study included 92 stroke patients attended within the RHP program and their matched-controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched-controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5% vs. 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group.OriginalityOur analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals but also to monitor health and resource use outcomes of care delivery

Publisher

Cold Spring Harbor Laboratory

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