Project

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How to improve care integration, coordination and continuity? Designing policy from population needs and preferences

Applicant Marti Joachim
Number 183447
Funding scheme NRP 74 Smarter Health Care
Research institution Institut Universitaire de Médecine Sociale et Préventive - IUMSP CHUV et Université de Lausanne
Institution of higher education University of Lausanne - LA
Main discipline Public Health and Health Services
Start/End 01.02.2019 - 31.01.2022
Approved amount 337'060.00
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All Disciplines (2)

Discipline
Public Health and Health Services
Economics

Keywords (5)

Patient preferences; Economic modelling; Continuity of care; Care integration; Multi-morbidity

Lay Summary (French)

Lead
Les personnes atteintes de maladies chroniques ont besoin de soins bien coordonnés. Cette étude vise à analyser le potentiel d’amélioration de la coordination des soins en Suisse et à proposer des modèles d’organisation et de financement des soins répondant aux besoins et aux préférences de la population.
Lay summary
Description du projet

Plusieurs sources de données seront utilisées pour mesurer la continuité des soins chez les personnes âgées de plus de 50 ans en Suisse ainsi que l’impact sur les coûts et la coordination des soins de la co-occurrence de plusieurs maladies chroniques. Ces informations proviendront de données administratives d’assurance maladie, d’études de cohorte et d’enquêtes populationnelles. Puis, les préférences de la population pour des mesures permettant une meilleure coordination des soins, telles que la digitalisation du dossier patient ou la mise en place de nouveaux mécanismes de financement, seront analysées à l’aide de techniques d’enquête expérimentales. Des solutions basées sur ces éléments et sur des discussions avec les acteurs-clés du système seront ensuite proposées. Enfin, leur impact à long terme, notamment sur les coûts des soins de santé, sera estimé.

Contexte

Le fédéralisme, les intérêts divergents des acteurs du système, le morcellement de l’information et la complexité des mécanismes de financement rendent l’intégration et la coordination des soins difficiles en Suisse. Les patients chroniques sont particulièrement concernés, notamment les personnes âgées multi-morbides dont la prise en charge complexe nécessite l’intervention d’un grand nombre de professionnels. Ce manque de continuité peut nuire à la qualité des soins, la pertinence des traitements, et renforcer la hausse des coûts des soins.

Objectif

Le but de l’étude est de proposer des conditions-cadres permettant d’améliorer la coordination des soins pour les patients chroniques en Suisse et de mesurer les bénéfices potentiels de nouveaux modèles d’organisation et de prise en charge. Il s’agira d’abord de quantifier l’ampleur du problème et de mieux comprendre les besoins et préférences de la population en matière de coordination des soins. L’impact sur le système de soins de modèles innovants permettant une meilleure coordination sera enfin mesuré.

Importance

Cette étude montrera le potentiel d’amélioration de la coordination des soins en Suisse et formulera des propositions concrètes pour mettre en place des modèles d’organisation et de financement innovants, acceptés par la population, et susceptibles de contribuer à une prise en charge plus efficiente des patients chroniques dans le pays.


Direct link to Lay Summary Last update: 04.02.2019

Lay Summary (English)

Lead
People with chronic conditions require coordinated care. This study analyses the potential for better care coordination in Switzerland and proposes new care models and financing mechanisms that are in line with the needs and preferences of the population.
Lay summary
Project description

The project will use several data sources to measure continuity of care in the 50+ population in Switzerland as well as the impact of multimorbidity on healthcare costs and coordination. These analyses will combine data from health insurance claims, cohort studies and population surveys. Then, preferences of the public for measures aimed at improving care coordination, such as the digitalisation of patient records or new payment mechanisms, will be investigated using experimental survey methods. The findings of the first phases complemented with structured discussions with key stakeholders will generate a set of innovative solutions. Finally, the long-term impact of these solutions, in particular on health care costs, will be assessed.

Background

Federalism, the diverging interests of stakeholders in the health care system, fragmented information systems and the complexity of current funding mechanisms hinders the delivery of integrated, well-coordinated health care in Switzerland. People with chronic conditions are particularly affected, especially elderly multi-morbid patients whose conditions require complex treatments from many different care providers. This lack of care continuity can have a negative impact on the effectiveness, quality and efficiency of care.

Aim 

The study aims to propose framework conditions for improving care coordination in Switzerland and to measure the value of new organisational and health care models. We will first determine the extent of the issue and gain a better understanding of the needs and preferences of the Swiss population with regard to health care coordination. We will then measure the potential impact of innovative models designed to improve coordination within the health care system.

Relevance

The study will show the potential for improving health care coordination in Switzerland and will make specific recommendations for new funding and organisational models that are acceptable to the public and could contribute to better and more efficient care for people with chronic conditions in the country.



Direct link to Lay Summary Last update: 04.02.2019

Responsible applicant and co-applicants

Employees

Project partner

Collaboration

Group / person Country
Types of collaboration
Health Economics Research Unit (HERU) - Aberdeen Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
University of Lucerne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
BFH Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Abstract

Background and rationaleHealth care systems worldwide are facing considerable challenges from the increasing number of chronic and multi-morbid patients, characterised by complex needs and frequent transitions between care settings. The federal structure of the Swiss healthcare system, the important division of responsibilities and complex financing mechanisms makes care integration particularly challenging in the country. The association between the number of chronic conditions and health care use and costs is well-documented. In addition, multi-morbid patients are particularly at risk of unnecessary repeated diagnostic tests, adverse drug interactions and patients safety issues more generally, and have lower quality of life. Care fragmentation and poor continuity of care (COC) are likely driving part of these expenditures and strategies aimed at improving care integration and coordination have the potential to generate efficiency gains in the system and improve population health and quality of life. Such strategies are multi-dimensional and involve addressing specific elements of the health care system (e.g. provider choice, gatekeeping, patient education, data sharing, interdisciplinarity). In Switzerland, there are more than 150 ongoing integrated care initiatives at various institutional levels, and while there is no specific federal regulatory framework for integrated care, managed care constitutes the main organisational and financing scheme for care coordination. A corollary to the improvement of COC is the need for integrated services to provide care that is centred on patients and that account for the needs and preferences of individuals. Accounting for patient preferences when designing innovative health policies is crucial to ensure acceptability, wide adoption and maximise the value of healthcare provided to the population. Overall, while the impact of multi-morbidity on costs and health-related quality of life has been well documented in the Swiss setting, little is known about the extent of COC issues at the population level, and in particular whether poor COC is concentrated in multi-morbid patients and associated with higher health care use and costs. In addition, while a large number of initiatives are currently in place to address issues of poor COC, the preferences of the population for potential new models of care have not been measured. Our project will combine analyses of secondary datasets, preferences elicitation methods, and simulation modelling to highlight optimal organisational and policy strategies to improve COC for patients with multiple chronic conditions. Overall objectivesThe general aim of this project is to provide an evidence base to support the design of organisational changes and policies aimed at improving COC for people with multiple chronic conditions in Switzerland, and ultimately improve efficiency in the system and value for patients. Specific aims1.Measure care continuity in Switzerland and assess the association between care continuity, multi-morbidity and costs. 2.Elicit preferences of the 50+ population for the main characteristics of new chronic care models and assess acceptability and potential uptake.3.Assess the long-term health economic impact of implementing new models that align with population preferences.MethodsIn the first phase of the project, we will use health insurance data to assess COC in the 50+ population. Validated measures of COC will be constructed from patient pathways and sequences of interactions with providers, and association between COC, multi-morbidity, and patient-level costs will be assessed. We will complement the claims data analysis with survey data to describe the population at risk of poor care continuity. We will then use discrete choice experiments to study preferences of the 50+ population for characteristics of chronic care models. The approach will first involve a literature search and a qualitative phase to inform the design of the experiment and ensure that we focus on the most relevant characteristics. Then, a data collection and analysis phase will quantify the relative importance of these characteristics and predict uptake in population subgroups. The third phase of the project will combine various data sources to make projections of the potential health economic impact of a set of hypothetical care models. Expected results and impactOur multidisciplinary approach and combination of qualitative and quantitative methods will form a strong evidence base to inform future policies. We will provide detailed quantitative assessments of COC in the country and of the health economic implications of poor COC. We will also describe the characteristics of patients groups in which poor COC is concentrated. We will then put a particular emphasis on measuring population preferences for new care models, which will allow us to determine their acceptability and identify appropriate incentives to promote their adoption. Our projections will describe potential impact of new models and highlight the key drivers of efficiency. Findings from the research phase of the project will be synthesised in an interactive tool to stimulate stakeholder engagement and improve transferability from research to policy. The project will have strong scientific impact through the application of innovative methodologies to both routinely collected and survey data, and the diversity of clinical and analytical expertise in our team will ensure that the value of the collected data is maximised. By involving stakeholders at various stages of the research and implementation phases, we will ensure impact is maximised. These activities will also be the opportunity to develop frameworks for stakeholder engagement in the area for future research and implementation projects.
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