title: Integrated care services: lessons learned from the deployment of the NEXES project.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en red, Enfermedades Respiratorias, University of Barcelona, Master Plan for Respiratory Diseases Ministry of Health Barcelona, Catalonia.
authors.forename: Carme
authors.initials: C
authors.lastname: Hernández
authors.affiliation: Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en red, Enfermedades Respiratorias, University of Barcelona, Barcelona, Catalonia.
authors.forename: Albert
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Centre de Recerca en Epidemiologia Ambiental.Centro de Investigación Biomédica en red de Epidemiologia y Salud Pública, Universitat Pompeu Fabra, Barcelona, Catalonia.
authors.forename: Judith
authors.initials: J
authors.lastname: Garcia-Aymerich
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Grimsmo
authors.affiliation: e-Health Unit, Sotiria Hospital, Athens, Greece.
authors.forename: Theodore
authors.initials: T
authors.lastname: Vontetsianos
authors.affiliation: Tic Salut. Tecnologia, Innovacio i Salut, Mataró, Catalonia.
authors.forename: Francesc
authors.initials: F
authors.lastname: García Cuyàs
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Catalonia.
authors.forename: Anna Garcia
authors.initials: AG
authors.lastname: Altes
authors.affiliation: 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vogiatzis
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Department of Health and Welfare Services, Trondheim, Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Garåsen
authors.affiliation: Centro en Investigación en Economía y Salud-CRES, Universitat Pompeu Fabra, Barcelona, Catalonia.
authors.forename: Laura
authors.initials: L
authors.lastname: Pellise
authors.affiliation: SINTEF, Information and Communication Technologies, Norway.
authors.forename: Leendert
authors.initials: L
authors.lastname: Wienhofen
authors.affiliation: Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en red, Enfermedades Respiratorias, University of Barcelona, Barcelona, Catalonia.
authors.forename: Isaac
authors.initials: I
authors.lastname: Cano
authors.affiliation: Tic Salut, Tecnologia, Innovacio i Salut, Mataró, Catalonia.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Meya
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Catalonia.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Moharra
authors.affiliation: Tic Salut. Tecnologia, Innovacio i Salut, Mataró, Catalonia.
authors.forename: Joan Ignasi
authors.initials: JI
authors.lastname: Martinez
authors.affiliation: Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en red, Enfermedades Respiratorias, University of Barcelona, Barcelona.
authors.forename: Juan
authors.initials: J
authors.lastname: Escarrabill
authors.affiliation: Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en red, Enfermedades Respiratorias, University of Barcelona, Barcelona, Catalonia.
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
keywords: case management; chronic disease; integrated health care systems; long-term care; telemedicine