title: Incorporating Budget Impact Analysis in the Implementation of Complex Interventions: A Case of an Integrated Intervention for Multimorbid Patients within the CareWell Study.
abstract: To develop a framework for the management of complex health care interventions within the Deming continuous improvement cycle and to test the framework in the case of an integrated intervention for multimorbid patients in the Basque Country within the CareWell project.
  
  
  
  Statistical analysis alone, although necessary, may not always represent the practical significance of the intervention. Thus, to ascertain the true economic impact of the intervention, the statistical results can be integrated into the budget impact analysis. The intervention of the case study consisted of a comprehensive approach that integrated new provider roles and new technological infrastructure for multimorbid patients, with the aim of reducing patient decompensations by 10% over 5 years. The study period was 2012 to 2020.
  
  
  
  Given the aging of the general population, the conventional scenario predicts an increase of 21% in the health care budget for care of multimorbid patients during the study period. With a successful intervention, this figure should drop to 18%. The statistical analysis, however, showed no significant differences in costs either in primary care or in hospital care between 2012 and 2014. The real costs in 2014 were by far closer to those in the conventional scenario than to the reductions expected in the objective scenario. The present implementation should be reappraised, because the present expenditure did not move closer to the objective budget.
  
  
  
  This work demonstrates the capacity of budget impact analysis to enhance the implementation of complex interventions. Its integration in the context of the continuous improvement cycle is transferable to other contexts in which implementation depth and time are important.
authors.affiliation: AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Kronikgune, Barakaldo, Spain. Electronic address: myriam.sotoruizdegordoa@osakidetza.eus.
authors.forename: Myriam
authors.initials: M
authors.lastname: Soto-Gordoa
authors.affiliation: AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Kronikgune Group, Barakaldo, Spain; Biodonostia Health Research Institute, San Sebastian-Donostia, Spain.
authors.forename: Arantzazu
authors.initials: A
authors.lastname: Arrospide
authors.affiliation: Biodonostia Health Research Institute, San Sebastian-Donostia, Spain; Tolosaldea Integrated Health Care Organization, Tolosa, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Merino Hernández
authors.affiliation: Kronikgune, Barakaldo, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Mora Amengual
authors.affiliation: Kronikgune, Barakaldo, Spain.
authors.forename: Ane
authors.initials: A
authors.lastname: Fullaondo Zabala
authors.affiliation: AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain.
authors.forename: Igor
authors.initials: I
authors.lastname: Larrañaga
authors.affiliation: Kronikgune, Barakaldo, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: de Manuel
authors.affiliation: AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Kronikgune Group, Barakaldo, Spain; Biodonostia Health Research Institute, San Sebastian-Donostia, Spain; Clinical Management Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Mar
mesh_terms: D002017:Budgets / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D006699:Home Care Services / Q000191:economics; D006801:Humans; D017059:Models, Econometric; D000071069:Multiple Chronic Conditions / Q000191:economics* / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D013030:Spain; D013689:Telephone / Q000191:economics; D017749:Total Quality Management / Q000191:economics / Q000458:organization & administration*
keywords: Deming cycle; discrete event simulation; integrated health care; planning