title: [Assessment of the effectiveness of a proactive and integrated healthcare programme for chronic complex patients].
abstract: OBJECTIVE
  To assess the effectiveness of a proactive and integrated care programme to adjust the use of health resources by chronic complex patients (CCP) identified as potential high consumers according to a predictive model based on prior use and morbidity.
  
  
  METHODS
  Randomized controlled clinical trial with three parallel groups of CCP: a blinded control group (GC), usual care; a partial intervention group (GIP) reported in the EMR; a total intervention group (GIT), also reported to primary care (PC). Conducted in an integrated health care organization (IHCO), N=128,281 individuals in 2011. Dependent variables: PC visits, emergency attention, hospitalizations, pharmaceutical cost and death.
  
  
  METHODS
  intervention group, age, sex, area of residence, morbidity (by clinical risk group) and recurrence as CCP.
  
  
  METHODS
  ANOVA, student's t test; logistic and multiple linear regressions at the 95% confidence level.
  
  
  RESULTS
  4,236 CCP included for the first intervention year and 4,223 for the second; recurrence as CCP 72%. Mean age 73.2 years, 54.2% women and over 70% with 2 or more chronic diseases. The number of PC visits was significantly higher for GIT than for GIP and GC. The hospital stays were significantly lower in GIP. This effect was observed in the first year and in the second year only in the new CCP. The general indicators of the IHCO were good, before and during the intervention.
  
  
  CONCLUSIONS
  A high standard of quality, previous and during the study, and the inevitable contamination between groups, hindered the assessment of the marginal effectiveness of the program.
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España. Electronic address: jcoderch@ssibe.cat.
authors: Jordi
authors: J
authors: Coderch
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España.
authors: Xavier
authors: X
authors: Pérez-Berruezo
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España.
authors: Inma
authors: I
authors: Sánchez-Pérez
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España.
authors: Elvira
authors: E
authors: Sánchez
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Centre de Recerca en Economia i Salut, Universitat Pompeu Fabra, , Barcelona, España.
authors: Pere
authors: P
authors: Ibern
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España.
authors: Marc
authors: M
authors: Pérez
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España.
authors: Marc
authors: M
authors: Carreras
authors: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà, Palamós (Girona), España.
authors: José M
authors: JM
authors: Inoriza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D016527:Drug Costs / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009017:Morbidity; D009026:Mortality; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D012008:Recurrence; D013030:Spain
keywords: Anciano frágil; Case management; Chronic disease; Efectividad; Effectiveness; Enfermedad crónica; Evaluación de programas; Frail elderly; Gestión de casos; Health resources; Integrated delivery of health care; Morbidity; Morbilidad; Prestación integrada de atención de salud; Program evaluation; Recursos en salud