The project deals with the fragmented health care and social services put on the research agenda by WHO in 2002. The focus of the project is integrated homecare (IHC) for patients with stroke, heart failure (HF) or COPD as the most promising solution derived from a systematic initial literature search.
The Homecare-partners have defined IHC as follows:
- IHC takes place in the home of the patient as part of an integrated care pathway between hospital services, primary care and/or social services for patients with specialized care and rehabilitation needs
- The IHC-pathway should be financially and administratively coordinated with a view to effectiveness and savings on stationary resources in health care and/or social services
- IHC is performed by a multidisciplinary team in collaboration with the patient in the home of the patient as well as in hospital passing possible general care needs to the community care setting
- The IHC-team focuses on effectiveness, quality, access and user satisfaction in an economic way and uses tele-facilities as far as they serve these goals
To reach a comprehensive evidence-based assessment of an organizational intervention as IHC, recognizing some uncertainty about the effects, best international practice towards a decision making tool seems to be to follow the line of a health technology assessment (HTA). Thus, the final purpose of the project is to do a HTA of IHC.
The Homecare-project has produced 3 levels of deliverables (D2-12) since Kick-off (D1) all of which are available at the project website
- HTA of IHC in EU (D12)
The core of the organisational efficacy across variants of IHC is patient psychological values associated with the home-setting:
The core evidence identified by meta-analysis assessing the effectiveness of the selected prototypes of IHC compared with usual hospital care may be summarized as follows:
- Perceived control over their care (feeling safe)
- Great involvement in decision-making (participation)
- Knowledge about their illness and its treatment (primary feedback)
- 14 randomised IHC stroke trials (N=2139 participants) with a median follow up of 6 months (range 3 – 12 months) conclude that patients who received IHC services were significantly less likely (p= 0.001) to be dead or dependent at the end of scheduled follow-up compared with those who received conventional care, Odds Ratio (OR)=0.75.
- 3 RCTs on IHC heart failure (N=551) each of which demonstrate significant reduction of all-cause readmissions conclude the following group effect of IHC heart failure compared to usual care: OR=0.60 (CI95%: 0.40-0.92).
- 3 RCTs (N=381) on IHC COPD each of which has significant reduced readmissions has the common odds ratio for readmission (OR) within 12 months: 0.5 (CI: 0.25-0.80).
The economic evaluation concludes that the interventions has an average net saving of 1450€ varying from 960€ by IHC COPD through 1920€ by IHC Stroke. Even by pessimistic assumptions are the net results not negative. The selected IHC interventions apply together to about 800,000 new patients each year in EU.
- Practical guides on IHC (D9-11)
Each of the three practical guides deals with the following 5 questions:
- What is IHC for patients suffering from Stroke, HF or COPD, respectively?
- What are the characteristics of the patients who may benefit from these services?
- What are the typical content, dose and timing delivered in IHC?
- What organisational competences are required for home-based interventions?
- What are the major challenges when implementing IHC?
- Deliverables 2-8 serve as inputs to the guides and/or the HTA
This includes RCTs of IHC stroke in both Denmark and Portugal, feasibility studies of IHC heart failure in both Sweden and the Netherlands, European surveys on:
- Components of IHC for HF and
- Barriers to IHC as well as the use of tele-rehabilitation in relation to IHC.
By a meso-strategy combining the dynamics of decentralization with the over-all planning qualities of a centralist approach, IHC may be disseminated as a package at the county hospital level for mutual benefit of patients and their carers and social economy.
To assure an accelerated dissemination in the best of quality some organized consultancy to frontrunner hospitals on the practical organization is highly recommended.
University of Southern Denmark,
DK-5230 Odense M
University of Aveiro,
Fundació Privada Clínic per a la Recerca Biomčdica,
Fondazione Ospedale San Camillo,
University of Glasgow,
Academy of Physical Education in Katowice,
Neurorehabilitation Centre Ringe,
Helle RM Jřrgensen
Neurorehabilitation Centre Brřnderslev,