Evaluation of the implementation of an integrated program for musculoskeletal system care.
BACKGROUND
The chronic nature of musculoskeletal diseases requires an integrated care which involves the Primary Care and the specialities of Rheumatology, Traumatology and Rehabilitation. The aim of this study was to assess the implementation of an integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease using Deming's continuous improvement process and considering referrals and resource consumption.


METHODS
A simulation model was used in the planning to predict the evolution of musculoskeletal diseases resource consumption and to carry out a Budget Impact Analysis from 2012 to 2020 in the Goierri-Alto Urola region. In the checking stage the status of the process in 2014 was evaluated using statistical analysis to check the degree of achievement of the objectives for each speciality.


RESULTS
Simulation models showed that population with musculoskeletal disease in Goierri-Alto Urola will increase a 4.4% by 2020. Because of that, the expenses for a conventional healthcare system will have increased a 5.9%. However, if the intervention reaches its objectives the budget would decrease an 8.5%. The statistical analysis evidenced a decline in referrals to Traumatology service and a reduction of successive consultations in all specialities.


CONCLUSIONS
The implementation of the integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease is still at an early stage. However, the empowerment of Primary Care improved patient referrals and reduced the costs.
Unidad de Investigación AP-OSI, OSI Alto Deba, Arrasate-Mondragón, España. Electronic address: igor.larranagauribetxebarria@osakidetza.net.
Igor
I
Larrañaga
Unidad de Investigación AP-OSI, OSI Alto Deba, Arrasate-Mondragón, España; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), Bilbao, España; Instituto Biodonostia, Donostia-San Sebastián, España.
Myriam
M
Soto-Gordoa
Unidad de Investigación AP-OSI, OSI Alto Deba, Arrasate-Mondragón, España; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), Bilbao, España; Instituto Biodonostia, Donostia-San Sebastián, España.
Arantzazu
A
Arrospide
Área Médica, OSI Goierri-Alto Urola, Zumárraga, España.
María Luz
ML
Jauregi
Unidad de Integración Asistencial, OSI Alto Deba, Arrasate-Mondragón, España.
Jesús
J
Millas
Centro de Salud de Zumárraga, OSI Goierri-Alto Urola, Zumárraga, España.
Ricardo
R
San Vicente
Unidad de Gestión Sanitaria, OSI Alto Deba, Arrasate-Mondragón, España.
Jabier
J
Aguirrebeña
Unidad de Investigación AP-OSI, OSI Alto Deba, Arrasate-Mondragón, España; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), Bilbao, España; Instituto Biodonostia, Donostia-San Sebastián, España; Unidad de Gestión Sanitaria, OSI Alto Deba, Arrasate-Mondragón, España.
Javier
J
Mar
D002017:Budgets; D002908:Chronic Disease; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017048:Health Care Costs; D006801:Humans; D008962:Models, Theoretical; D009140:Musculoskeletal Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D012046:Rehabilitation / Q000458:organization & administration*; D012219:Rheumatology / Q000458:organization & administration*; D013030:Spain / Q000453:epidemiology; D014194:Traumatology / Q000458:organization & administration*
Aparato locomotor; Ciclo de Deming; Cost and cost analysis; Coste y análisis de coste; Decision support techniques; Deming's cycle; Integrated health care; Mejora de la calidad; Musculoskeletal system; Organización sanitaria integrada; Quality improvement; Técnicas de soporte a las decisiones