UPDATE (May 2017) of “Evaluation of the implementation of the integrated programme for multimorbid patients in Basque Country”RESULT OF Commitment Predictive Modelling B3 (ID4563)
*- Current Status:This simulation modelling formulated two hypotheses by defining key elements derived from extrapolating resource consumption to 2020, and modelling the anticipated increase of care cost for multi-morbid patients due to ageing. The model is based on the objective of reducing the costs for unstable conditions in patients according to the results of the Basque pilot site. On this basis, the model predicts cumulative savings of more than half a million euros.
The application of the developed framework to manage the implementation of integrated programs for multi-morbid patients in big corporations like the Basque Health Service has also been accomplished. The budget impact showed that the burden of multimorbid patients would decrease by 13% if the results of the pilot site were scalable to the whole Basque population. The statistical analysis has included the use of propensity score and genetic matching to minimize the selection bias inherent to real-world data studies. Multivariate analyses have been implemented to carry out the subgroup analysis to identify within the target population those patients with better results. The subgroup analysis suggest that in cases in which the general practitioner's clinical judgement agreed with the risk stratification for case finding, the patients' primary care contacts were increased and in-hospitalizations were reduced. And therefore, that The intervention achieved its objective in those multimorbid patients that could benefit from increased assistance but did not require palliative care. Furthermore, results show that not only the reach of the intervention but also the contact frequency is crucial for attaining the objective.
The framework has also been applied to the Vento region. Our work demonstrates that even soon to make conclusive statements because of the initial phase of the deployment, the integrated program was not sufficiently implemented, and therefore, it was not effective so far. However, the LHSA of Feltre achieved to reduce the burden of the multimorbid patients, being the total cost of these patients closer to the set objective that to the cost that the organization might have incurred if no measures were taken.