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Pérez-Montes de Oca A, Ricou Ríos L, López Seguí F, Alonso N. Economic impact of introducing a multidisciplinary diabetic foot clinic in a tertiary hospital. Med Clin (Barc) 2024:S0025-7753(24)00167-2. [PMID: 38653617 DOI: 10.1016/j.medcli.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Alejandra Pérez-Montes de Oca
- Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Ricou Ríos
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain; CRES (Centre de Recerca en Economia i Salut) - Pompeu Fabra University, Barcelona, Spain; Research Group on Innovation, Health Economics and Digital Transformation - Institut Germans Trias i Pujol, Spain
| | - Francesc López Seguí
- CRES (Centre de Recerca en Economia i Salut) - Pompeu Fabra University, Barcelona, Spain
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Hernández Guillamet G, Morancho Pallaruelo AN, Miró Mezquita L, Miralles R, Mas MÀ, Ulldemolins Papaseit MJ, Estrada Cuxart O, López Seguí F. Correction: Machine Learning Model for Predicting Mortality Risk in Patients With Complex Chronic Conditions: Retrospective Analysis. Online J Public Health Inform 2024; 16:e58453. [PMID: 38513230 PMCID: PMC10995781 DOI: 10.2196/58453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
[This corrects the article DOI: 10.2196/52782.].
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Affiliation(s)
- Guillem Hernández Guillamet
- Research Group on Innovation, Health Economics and Digital TransformationInstitut Germans Trias i PujolBadalonaSpain
- Hospital Germans Trias i PujolInstitut Català de la SalutBadalonaSpain
| | | | - Laura Miró Mezquita
- Research Group on Innovation, Health Economics and Digital TransformationInstitut Germans Trias i PujolBadalonaSpain
- Hospital Germans Trias i PujolInstitut Català de la SalutBadalonaSpain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana NordInstitut Català de la SalutBadalonaSpain
- Department of GeriatricsHospital Germans Trias i PujolBadalonaSpain
| | - Miquel Àngel Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana NordInstitut Català de la SalutBadalonaSpain
- Department of GeriatricsHospital Germans Trias i PujolBadalonaSpain
| | - María José Ulldemolins Papaseit
- Direcció d’Atenció Primària Metropolitana NordInstitut Català de la SalutBadalonaSpain
- Servei d’Atenció Primària Barcelonès NordInstitut Català de la SalutBarcelonaSpain
| | - Oriol Estrada Cuxart
- Research Group on Innovation, Health Economics and Digital TransformationInstitut Germans Trias i PujolBadalonaSpain
- Hospital Germans Trias i PujolInstitut Català de la SalutBadalonaSpain
| | - Francesc López Seguí
- Hospital Germans Trias i PujolInstitut Català de la SalutBadalonaSpain
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS)University of Vic - Central University of Catalonia (UVic-UCC)VicSpain
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Codina P, Vicente Gómez JÁ, Hernández Guillamet G, Ricou Ríos L, Carrete A, Vilalta V, Estrada O, Ara J, Lupón J, Bayés-Genís A, López Seguí F. Assessing the impact of haemodynamic monitoring with CardioMEMS on heart failure patients: a cost-benefit analysis. ESC Heart Fail 2024. [PMID: 38500304 DOI: 10.1002/ehf2.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
AIMS The objective of this study was to perform a cost-benefit analysis of the CardioMEMS HF System (Abbott Laboratories, Abbott Park, IL, USA) in a heart failure (HF) clinic in Spain by evaluating the real-time remote monitoring of pulmonary artery pressures, which has been shown to reduce HF-related hospitalizations and improve the quality of life for selected HF patients. Particularly, the study aimed to determine the value of CardioMEMS in Southern Europe, where healthcare costs are significantly lower and its effectiveness remains uncertain. METHODS AND RESULTS This single-centre study enrolled all consecutive HF patients (N = 43) who had been implanted with a pulmonary artery pressure sensor (CardioMEMS HF System); 48.8% were females, aged 75.5 ± 7.0 years, with both reduced and preserved left ventricular ejection fraction; 67.4% of them were in New York Heart Association Class III. The number of HF hospitalizations in the year before and the year after the sensor implantation was compared. Quality-adjusted life years gained based on a literature review of previous studies were calculated. The rate of HF hospitalizations was significantly lower at 1 year compared with the year before CardioMEMS implantation (0.25 vs. 1.10 events/patient-year, hazard ratio 0.22, P = 0.001). At the end of the first year, the usual management outperformed the CardioMEMS HF System. By the end of the second year, the CardioMEMS system is estimated to reduce costs compared with usual management (net benefits of €346). CONCLUSIONS Based on the results, we suggest that remote monitoring of pulmonary artery pressure with the CardioMEMS HF System represents a midterm and long-term efficient strategy in a healthcare setting in Southern Europe.
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Affiliation(s)
- Pau Codina
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - José Ángel Vicente Gómez
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Guillem Hernández Guillamet
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- eXiT Research Group-Control Engineering and Intelligent Systems (IIiA-UdG), Girona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Laura Ricou Ríos
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Andrea Carrete
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Estrada
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Jordi Ara
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Antoni Bayés-Genís
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Francesc López Seguí
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Castillo-Rodenas M, Vicente Gómez JÁ, Fuster-Casanovas A, Miró Catalina Q, Vidal-Alaball J, López Seguí F. Impact of COVID-19 on the Pediatric Primary Care Model in Catalonia: Analysis of Changes in the Number and Type of Face-to-Face and Remote Visits. JMIR Pediatr Parent 2024; 7:e49943. [PMID: 38532544 PMCID: PMC11004613 DOI: 10.2196/49943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 03/28/2024] Open
Abstract
Background The outbreak of COVID-19 has turned the care model of health systems around the world upside down. The health care crisis has led to opportunities for digital health to deliver quality care, and the system has been redirected toward telemedicine. In Catalonia, Spain, as of March 2020, the pattern of visits in primary care pediatric consultations changed, such that face-to-face visits decreased in favor of non-face-to-face visits. Objective This study aimed to analyze variations in the types of pediatric visits in primary care centers in Catalonia before and after the onset of COVID-19. Methods This was a descriptive observational study based on administrative data. The number and type of visits to primary care pediatric services in Catalonia between January 2019 and December 2022 were studied. Results A drop of more than 80% in face-to-face visits and an increase of up to 15 times in remote visits were observed as of March 2020 compared to the previous year. Subsequently, the face-to-face attendance rate began to recover, although it did not reach the same rate as before COVID-19. Non-face-to-face visits were maintained, representing more than 20% of the total after more than 2 years of the pandemic. Conclusions COVID-19 has been the trigger for a transition in the types of visits to primary care pediatric services. The COVID-19 pandemic was a clear catalyst for the integration of telemedicine in Catalan pediatric health care. In this context, although face-to-face consultations have recovered in absolute numbers, after the pandemic period, the weight of telemedicine has increased.
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària Cardona, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | | | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Francesc López Seguí
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Castillo-Rodenas M, Vidal-Alaball J, Solanas-Bacardit N, Farràs-Company C, Fuster-Casanovas A, Miró Catalina Q, López Seguí F. Correction: Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study. JMIR Res Protoc 2024; 13:e57937. [PMID: 38442371 PMCID: PMC10951821 DOI: 10.2196/57937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024] Open
Abstract
[This corrects the article DOI: 10.2196/52946.].
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària CardonaGerència Territorial de la Catalunya CentralInstitut Català de la SalutCardonaSpain
| | - Josep Vidal-Alaball
- Cap de la Unitat de Suport a la Recerca de la Catalunya CentralFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i GurinaSant Fruitós de BagesSpain
- Health Promotion in Rural Areas Research GroupGerència Territorial de la Catalunya CentralInstitut Català de la SalutSant Fruitós de BagesSpain
- Faculty of MedicineUniversity of Vic–Central University of CataloniaVicSpain
| | - Núria Solanas-Bacardit
- Centre d'Atenció Primària CardonaGerència Territorial de la Catalunya CentralInstitut Català de la SalutCardonaSpain
| | - Clotilde Farràs-Company
- Direcció del Centre d'Atenció Primària CardonaGerència Territorial de la Catalunya CentralInstitut Català de la SalutCardonaSpain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya CentralFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i GurinaSant Fruitós de BagesSpain
| | - Queralt Miró Catalina
- Health Promotion in Rural Areas Research GroupGerència Territorial de la Catalunya CentralInstitut Català de la SalutSant Fruitós de BagesSpain
- Unitat de Suport a la Recerca de la Catalunya CentralFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i GurinaSant Fruitós de BagesSpain
| | - Francesc López Seguí
- Chair in ICT and HealthCentre for Health and Social Care ResearchUniversity of Vic–Central University of CataloniaVicSpain
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Castillo-Rodenas M, Vidal-Alaball J, Solanas-Bacardit N, Farràs-Company C, Fuster-Casanovas A, Miró Catalina Q, López Seguí F. Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study. JMIR Res Protoc 2024; 13:e52946. [PMID: 38300693 PMCID: PMC10870202 DOI: 10.2196/52946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non-face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families' access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications. OBJECTIVE The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals. METHODS We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family's side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard. RESULTS Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits. CONCLUSIONS We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52946.
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Josep Vidal-Alaball
- Cap de la Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Núria Solanas-Bacardit
- Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Clotilde Farràs-Company
- Direcció del Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Francesc López Seguí
- Chair in ICT and Health, Centre for Health and Social Care Research, University of Vic–Central University of Catalonia, Vic, Spain
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Hernández Guillamet G, Morancho Pallaruelo AN, Miró Mezquita L, Miralles R, Mas MÀ, Ulldemolins Papaseit MJ, Estrada Cuxart O, López Seguí F. Machine Learning Model for Predicting Mortality Risk in Patients With Complex Chronic Conditions: Retrospective Analysis. Online J Public Health Inform 2023; 15:e52782. [PMID: 38223690 PMCID: PMC10784974 DOI: 10.2196/52782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/18/2023] [Indexed: 01/16/2024] Open
Abstract
Background The health care system is undergoing a shift toward a more patient-centered approach for individuals with chronic and complex conditions, which presents a series of challenges, such as predicting hospital needs and optimizing resources. At the same time, the exponential increase in health data availability has made it possible to apply advanced statistics and artificial intelligence techniques to develop decision-support systems and improve resource planning, diagnosis, and patient screening. These methods are key to automating the analysis of large volumes of medical data and reducing professional workloads. Objective This article aims to present a machine learning model and a case study in a cohort of patients with highly complex conditions. The object was to predict mortality within the following 4 years and early mortality over 6 months following diagnosis. The method used easily accessible variables and health care resource utilization information. Methods A classification algorithm was selected among 6 models implemented and evaluated using a stratified cross-validation strategy with k=10 and a 70/30 train-test split. The evaluation metrics used included accuracy, recall, precision, F1-score, and area under the receiver operating characteristic (AUROC) curve. Results The model predicted patient death with an 87% accuracy, recall of 87%, precision of 82%, F1-score of 84%, and area under the curve (AUC) of 0.88 using the best model, the Extreme Gradient Boosting (XGBoost) classifier. The results were worse when predicting premature deaths (following 6 months) with an 83% accuracy (recall=55%, precision=64% F1-score=57%, and AUC=0.88) using the Gradient Boosting (GRBoost) classifier. Conclusions This study showcases encouraging outcomes in forecasting mortality among patients with intricate and persistent health conditions. The employed variables are conveniently accessible, and the incorporation of health care resource utilization information of the patient, which has not been employed by current state-of-the-art approaches, displays promising predictive power. The proposed prediction model is designed to efficiently identify cases that need customized care and proactively anticipate the demand for critical resources by health care providers.
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Affiliation(s)
- Guillem Hernández Guillamet
- Research Group on Innovation, Health Economics and Digital Transformation Institut Germans Trias i Pujol Badalona Spain
- Hospital Germans Trias i Pujol Institut Català de la Salut Badalona Spain
| | | | - Laura Miró Mezquita
- Research Group on Innovation, Health Economics and Digital Transformation Institut Germans Trias i Pujol Badalona Spain
- Hospital Germans Trias i Pujol Institut Català de la Salut Badalona Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord Institut Català de la Salut Badalona Spain
- Department of Geriatrics Hospital Germans Trias i Pujol Badalona Spain
| | - Miquel Àngel Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord Institut Català de la Salut Badalona Spain
- Department of Geriatrics Hospital Germans Trias i Pujol Badalona Spain
| | - María José Ulldemolins Papaseit
- Direcció d'Atenció Primària Metropolitana Nord Institut Català de la Salut Badalona Spain
- Servei d'Atenció Primària Barcelonès Nord Institut Català de la Salut Barcelona Spain
| | - Oriol Estrada Cuxart
- Research Group on Innovation, Health Economics and Digital Transformation Institut Germans Trias i Pujol Badalona Spain
- Hospital Germans Trias i Pujol Institut Català de la Salut Badalona Spain
| | - Francesc López Seguí
- Hospital Germans Trias i Pujol Institut Català de la Salut Badalona Spain
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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López Seguí F, Cos Codina J, Ricou Ríos L, Martínez Segura MI, Miró Mezquita L, Escrich Navarro R, Davins Riu M, Estrada Cuxart O, Anashkin Kachalin G, Moreno-Martínez D. Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study. JMIR Hum Factors 2023; 10:e47390. [PMID: 37801353 PMCID: PMC10589830 DOI: 10.2196/47390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/13/2023] [Accepted: 08/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. OBJECTIVE This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. METHODS We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. RESULTS In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. CONCLUSIONS The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation.
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Affiliation(s)
- Francesc López Seguí
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
- Chair in ICT and Health, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Spain
| | - Joan Cos Codina
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Laura Ricou Ríos
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - María Isabel Martínez Segura
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Laura Miró Mezquita
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Raquel Escrich Navarro
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Meritxell Davins Riu
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Oriol Estrada Cuxart
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - German Anashkin Kachalin
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Daniel Moreno-Martínez
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
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Ricou Ríos L, Esposito Català C, Pons Calsapeu A, Adroher Mas C, Andrés Martínez I, Nuño Ruiz I, Castellà Creus M, Castellà Fàbregas L, García Quesada MJ, Estrada Cuxart O, Ara Del Rey J, López Seguí F. Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis. Cost Eff Resour Alloc 2023; 21:67. [PMID: 37716948 PMCID: PMC10505311 DOI: 10.1186/s12962-023-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. The objective of the study is to evaluate previously to the implementation whether the benefits of introducing ultrasound-guided peripheral venous catheters, midline catheters and peripherally inserted central catheters compared to current practice by a vascular access specialist team outweigh their costs. METHODS Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when changing the current practice for the use of ultrasound-guided midline and PICC catheters, as well as the additional resources required for their use. RESULTS The use of an ultrasound-guided device on peripherally inserted central carheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, the use of an ultrasound-guided device on a midline catheter, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. CONCLUSION The benefits of using ultrasound-guided midline and PICC catheters compared to current practice by introducing a vascular access specialist team trained in the implantation of ultrasound-guided catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of phebitis. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.
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Affiliation(s)
- Laura Ricou Ríos
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Barcelona, Spain
| | - Candela Esposito Català
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Arnau Pons Calsapeu
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Cristina Adroher Mas
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Isabel Andrés Martínez
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
| | - Isaac Nuño Ruiz
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
| | - Mònica Castellà Creus
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- Direcció Infermera. Àrea de Qualitat. Gerència Metropolitana Nord, Hospital Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Laia Castellà Fàbregas
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Maria José García Quesada
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Oriol Estrada Cuxart
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Ara Del Rey
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Francesc López Seguí
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Barcelona, Spain.
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Guillamet GH, Seguí FL, Vidal-Alaball J, López B. CauRuler: Causal irredundant association rule miner for complex patient trajectory modelling. Comput Biol Med 2023; 155:106636. [PMID: 36780801 DOI: 10.1016/j.compbiomed.2023.106636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Discovering causal associations between variables is one of the main goals of clinical trials, with the ultimate aim of identifying the causes of specific health status. Prior knowledge of causal paths could help ensure patients do not develop the resultant conditions. In recent years, thanks to the enormous amount of health data stored with the support of digital tools, attempts have been made to employ Machine Learning to infer causality. Those methodologies suffer from some deficiencies in controlling cofounders when analysing causality, as well as providing causal rules general enough to be useful in healthcare practice. Conversely, this work presents and evaluates CauRuler, a new approach to deal with causality from association rules. The proposed approach uses a pruning strategy to reduce the association rule set, which does not compromise the causality learning capability of the algorithm. This behaviour makes the algorithm suitable for exploiting large health databases with thousands of patients and medical instances. CauRuler can control a larger number of confounders than other proposals, bringing robustness to causal analysis and avoiding the identification of spurious associations. Additionally, the method generalizes causality using anti-monotone properties to obtain complex and general causal paths. The method can target correct causal associations in complex medical databases with retrospective data. METHOD CauRuler extends association rule mining with an irredundancy property so that the set of rules learnt is reduced in size and generalized. General association rules, conformed by fewer items, enable controlling more confounding variables to verify, with more statistical evidence on available data, if they represent causal paths in patient disease trajectories. RESULTS CauRuler has been tested on a complex real medical database (3,5 M visits to the primary care services between 2019 and 2020, and controlling over 15.000 different variables including diagnoses and demographic and other clinical patient data). The reduction of the rule set achieved by the pruning strategy goes from 7.732 to 2.240 rules, from which 46 have been found to have causality relationships in the patient trajectories, and generalized to 14 rules tested as true causal relationships thanks to the confounding analysis. These rules have been validated by clinicians with the support of a graphical map. The obtained causal paths control in average of 906 confounder variables, retrieving robust results. CONCLUSIONS Causal relationships enable predicting causal paths between health conditions according to patient trajectories. Knowing these causal paths is crucial for understanding and preventing the appearance or worsening of diseases in patients. CauRuler, with high demanding thresholds, has proven its efficiency and effectiveness in targeting previously known causal associations between diagnoses, reaching consensus in the medical community. Softening these thresholds should help target interesting general causal paths.
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Affiliation(s)
- Guillem Hernández Guillamet
- eXiT Research Group, Universitat de Girona (UdG), EPS - Edifici P-IV, Carrer Universitat de Girona, 6, Girona, 17003, Catalunya, Spain; Assistance strategy management. Hospital Germans Trias i Pujol, (ICS), Carretera de Canyet, Badalona, 08916, Catalunya, Spain; Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol (IGTP), Cami de les Escoles, Badalona, 08916, Catalunya, Spain.
| | - Francesc López Seguí
- Assistance strategy management. Hospital Germans Trias i Pujol, (ICS), Carretera de Canyet, Badalona, 08916, Catalunya, Spain; Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol (IGTP), Cami de les Escoles, Badalona, 08916, Catalunya, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group. Gerencia Territorial de la Catalunya Central, ICS, Carrer Pica d'Estats, 13-15, 08272, Sant Fruitos de Bages, Catalunya, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Fundacio Institut Universitari per a la Recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Catalunya, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia, Ctra. de Roda, 70, 08500, Vic, Catalunya, Spain
| | - Beatriz López
- eXiT Research Group, Universitat de Girona (UdG), EPS - Edifici P-IV, Carrer Universitat de Girona, 6, Girona, 17003, Catalunya, Spain
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López Seguí F, Oyón Lerga U, Laguna Marmol L, Coll P, Andreu A, Meulbroek M, López Casasnovas G, Estrada Cuxart O, Ara Rey J, Quiñones C, Pérez F, Fernandez J, Rivero À, Ricou Ríos L, Clotet B. Cost-effectiveness analysis of the daily HIV pre-exposure prophylaxis in men who have sex with men in Barcelona. PLoS One 2023; 18:e0277571. [PMID: 36649273 PMCID: PMC9844874 DOI: 10.1371/journal.pone.0277571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/28/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia after the approval of the PrEP, a territory with extensive implementation. METHODS Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price) compared with non-implementation. A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. RESULTS Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. CONCLUSIONS The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.
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Affiliation(s)
- Francesc López Seguí
- Hospital Germans Trias i Pujol, Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
- Fundació Lluita Contra les Infeccions, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
- * E-mail:
| | | | | | - Pep Coll
- Fundació Lluita Contra les Infeccions, Barcelona, Spain
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
| | | | | | | | | | | | | | - Fèlix Pérez
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | | | - Àngel Rivero
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | - Laura Ricou Ríos
- Hospital Germans Trias i Pujol, Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita Contra les Infeccions, Barcelona, Spain
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
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Adroher Mas C, Calvo Aroca C, Casadevall Llandrich R, López Seguí F, Martin Carpi J, García-Cuyàs F. Evaluation of the Effectiveness of Telemedicine Visits in a Pediatric Gastroenterology Service in the Context of COVID-19. Int J Environ Res Public Health 2022; 19:15999. [PMID: 36498072 PMCID: PMC9740743 DOI: 10.3390/ijerph192315999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND During the first months of COVID-19, the Gastroenterology, Hepatology and Nutrition service of the Hospital Sant Joan de Déu in Barcelona, a leading pediatric center in Spain, introduced a new model of non-face-to-face care. OBJECTIVE To evaluate the impact of telephone consultations compared to those conducted face-to-face on healthcare utilization. METHODOLOGY Two main indicators of effectiveness are used: the degree of resolution (percentage of first telemedicine visits that did not generate any new visits in the following 4 and 12 months) and the average number of subsequent visits. A distinction was made between visits for general pathologies (less complex) and those for pathologies treated in monographic consultations (chronic or complex pathologies). Effectiveness at 4 and 12 months was also compared. RESULTS After 4 months from the first visit, the degree of resolution is lower in the first telemedicine visits than in face-to-face visits for both general pathologies and those of monographic agendas for chronic and complex pathologies. After twelve months, the first general telemedicine visits are less resolute than face-to-face visits, while the resolution rate is the same for chronic and complex pathology visits. Each telemedicine visit generates on average more visits than face-to-face visits. In the short term, 133.4% more in the case of general visits and 51.4% more in the case of chronic and complex visits. In the long term, general telemedicine visits generate 57.31% more visits, while no statistically significant difference is observed between chronic and complex face-to-face and telemedicine visits. CONCLUSION The results of this study show that the resolution capacity of the non-face-to-face model in pediatric care in the pandemic context is generally lower and generates more successive visits than the face-to-face model. This lower performance of the telemedicine model should be counterbalanced with its advantages.
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Affiliation(s)
- Cristina Adroher Mas
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain
- Center for Research in Health and Economics, Pompeu Fabra University (CRES-UPF), 08002 Barcelona, Spain
| | - Celia Calvo Aroca
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain
- Center for Research in Health and Economics, Pompeu Fabra University (CRES-UPF), 08002 Barcelona, Spain
| | | | - Francesc López Seguí
- Center for Research in Health and Economics, Pompeu Fabra University (CRES-UPF), 08002 Barcelona, Spain
| | - Javier Martin Carpi
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain
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Galdeano Lozano M, Alfaro Álvarez JC, Parra Macías N, Salas Campos R, Heili Frades S, Montserrat JM, Rosell Gratacós A, Abad Capa J, Parra Ordaz O, López Seguí F. Effectiveness of Intermediate Respiratory Care Units as an Alternative to Intensive Care Units during the COVID-19 Pandemic in Catalonia. Int J Environ Res Public Health 2022; 19:ijerph19106034. [PMID: 35627571 PMCID: PMC9141338 DOI: 10.3390/ijerph19106034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Objectives: During the COVID-19 pandemic, the risk of collapse for the health system created great difficulties. We will demonstrate that intermediate respiratory care units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important for patients with SARS-CoV-2 pneumonia. Methods: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. Results: 991 patients were admitted, 56 to the IRCU (from a of 81 admitted to the critical care unit). Mean age was 65 years (SD 12.8), Barthel index 75 (SD 8.3), Charlson comorbidity index 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. A significant relationship (p < 0.05) with higher mortality was noted for the following parameters: fever greater than or equal to 39 °C [OR 5.6; 95% CI (1.2−2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1−0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1−12.3); p = 0.025]. NIMV had less of a negative impact [OR 1.8; 95% CI (0.4−8.4); p = 0.423] than IOI. The total cost of the IRCU amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. Conclusions: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.
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Affiliation(s)
- Marina Galdeano Lozano
- Unidad de Ventilación y Cuidados Respiratorios Intermedios, Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, Reseau Europén de Recherche en Ventilation Artificielle (REVA), 08193 Barcelona, Spain
- Unidad de Economía de la Salud, Dirección de Innovación de la Gerencia Territorial Metropolitana Norte, Institut Català de la Salut, 08007 Barcelona, Spain;
- Doctorat de Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, 08193 Barcelona, Spain;
- Correspondence: ; Tel.: +34-934661200 (ext. 3603)
| | | | - Núria Parra Macías
- Unidad de Innovación Clínica y Promoción de la Salud, Hospital Universitario Sagrat Cor, Grupo Quirón Salud, 08029 Barcelona, Spain;
| | - Rosario Salas Campos
- Servicio de Medicina Interna, Hospital Universitario Sagrat Cor, Quirón Salud, 08029 Barcelona, Spain;
| | - Sarah Heili Frades
- Unidad de Cuidados Intermedios Respiratorios, Hospital Fundación Jimenez Díaz, Grupo Quirón Salud, Reseau Europén de Recherche en Ventilation Artificielle, 28040 Madrid, Spain;
| | - Josep Maria Montserrat
- Unidad del Sueño, Servicio de Neumología, Hospital Clínic Provincial Barcelona, Universitat de Barcelona, 08193 Barcelona, Spain;
| | - Antoni Rosell Gratacós
- Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain; (A.R.G.); (J.A.C.)
| | - Jorge Abad Capa
- Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain; (A.R.G.); (J.A.C.)
| | - Olga Parra Ordaz
- Doctorat de Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, 08193 Barcelona, Spain;
- Unidad de Sueño Servicio de Neumología, Hospital Universitario Sagrat Cor, Quirón Salud, 08029 Barcelona, Spain
| | - Francesc López Seguí
- Unidad de Economía de la Salud, Dirección de Innovación de la Gerencia Territorial Metropolitana Norte, Institut Català de la Salut, 08007 Barcelona, Spain;
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Adroher Mas C, Esposito Català C, Batlle Boada A, Casadevall Llandrich R, Millet Elizalde M, García García JJ, Del Castillo Rey M, García Cuyàs F, Pons Serra M, López Seguí F. Pediatric Tele-Home Care Compared to Usual Care: Cost-Minimization Analysis. JMIR Pediatr Parent 2022; 5:e31628. [PMID: 35049513 PMCID: PMC8814920 DOI: 10.2196/31628] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. OBJECTIVE The aim of this study is to compare the average cost of a discharge by tele-home care with the usual care and to analyze the main drivers of the differential costs of both care models. METHODS A cost-minimization analysis is conducted under a hospital's perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. RESULTS A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. CONCLUSIONS The cost analysis conducted under a hospital perspective shows that pediatric tele-home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.
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Affiliation(s)
- Cristina Adroher Mas
- Sant Joan de Déu Hospital, Catalan Ministry of Health, Esplugues de Llobregat, Spain.,Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain
| | | | - Astrid Batlle Boada
- Sant Joan de Déu Hospital, Catalan Ministry of Health, Esplugues de Llobregat, Spain
| | | | - Marta Millet Elizalde
- Sant Joan de Déu Hospital, Catalan Ministry of Health, Esplugues de Llobregat, Spain
| | | | | | - Francesc García Cuyàs
- Sant Joan de Déu Hospital, Catalan Ministry of Health, Esplugues de Llobregat, Spain
| | - Miquel Pons Serra
- Sant Joan de Déu Hospital, Catalan Ministry of Health, Esplugues de Llobregat, Spain
| | - Francesc López Seguí
- Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain
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Roig Cabo P, López Seguí F, Sierra Lujan RM, Seda Gombau G, Moreno Millán N, Torán Monserrat P. [Impact of the eConsultation on the primary care agenda]. Aten Primaria 2021; 53:102070. [PMID: 33971582 PMCID: PMC8120856 DOI: 10.1016/j.aprim.2021.102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/18/2020] [Accepted: 02/26/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE A «before and after» type observational study was carried out to assess the impact of the virtual consultation (eConsulta) on the frequency with which the patient visits their primary care center once they have had their first virtual consultation. SETTING Assigned population of the primary care center of Masnou-Alella and Ocata-Teià, Catalan Health Institute. PARTICIPANTS A random sampling was performed and 329 patients who engaged in eConsulta were compared with 329 statistically similar patients in age, sex and medical complexity who did not engage in eConsulta. PRINCIPAL MEDIATIONS Visits with primary care and nursing in their team are measured, both face-to-face, telephone and eConsulta, over the study period. RESULTS Patients who performed virtual consultations showed a previous frequent attendance in primary care higher than those who did not perform eConsulta (4.44 medical visits year/versus 3.11). Following the use of the eConsulta, after a year of follow-up, frequency was reduced to levels of the control group (3.16 medical visits/year versus 3.00). After the first virtual visit, patients reduced face-to-face visits by 28.7%. CONCLUSIONS The eConsulta could be an effective tool to respond to the needs of patients who do not require a face-to-face visit, especially in the most frequent patients.
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Affiliation(s)
- Pascual Roig Cabo
- EAP El Masnou-Alella, Institut Català de la Salut, Masnou, Barcelona, España.
| | - Francesc López Seguí
- TIC Salut Social, Ministry of Health, CRES&CEXS - Pompeu Fabra University, Barcelona, España
| | | | - Gemma Seda Gombau
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), Mataró, Barcelona, España
| | | | - Pere Torán Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), Mataró, Barcelona, España
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López Seguí F, Navarrete Duran JM, Tuldrà A, Sarquella M, Revollo B, Llibre JM, Ara del Rey J, Estrada Cuxart O, Paredes Deirós R, Hernández Guillamet G, Clotet Sala B, Vidal Alaball J, Such Faro P. Impact of Mass Workplace COVID-19 Rapid Testing on Health and Healthcare Resource Savings. Int J Environ Res Public Health 2021; 18:7129. [PMID: 34281065 PMCID: PMC8297152 DOI: 10.3390/ijerph18137129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 12/20/2022]
Abstract
Background: The epidemiological situation generated by COVID-19 has cast into sharp relief the delicate balance between public health priorities and the economy, with businesses obliged to toe the line between employee health and continued production. In an effort to detect as many cases as possible, isolate contacts, cut transmission chains, and limit the spread of the virus in the workplace, mass testing strategies have been implemented in both public health and industrial contexts to minimize the risk of disruption in activity. Objective: To evaluate the economic impact of the mass workplace testing strategy as carried out by a large automotive company in Catalonia in terms of health and healthcare resource savings. Methodology: Analysis of health costs and impacts based on the estimation of the mortality and morbidity avoided because of screening, and the resulting savings in healthcare costs. Results: The economic impact of the mass workplace testing strategies (using both PCR and RAT tests) was approximately €10.44 per test performed or €5575.49 per positive detected; 38% of this figure corresponds to savings derived from better use of health resources (hospital beds, ICU beds, and follow-up of infected cases), while the remaining 62% corresponds to improved health rates due to the avoided morbidity and mortality. In scenarios with higher positivity rates and a greater impact of the infection on health and the use of health resources, these results could be up to ten times higher (€130.24 per test performed or €69,565.59 per positive detected). Conclusion: In the context of COVID-19, preventive actions carried out by the private sector to safeguard industrial production also have concomitant public benefits in the form of savings in healthcare costs. Thus, governmental bodies need to recognize the value of implementing such strategies in private settings and facilitate them through, for example, subsidies.
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Affiliation(s)
- Francesc López Seguí
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (J.A.d.R.); (O.E.C.)
| | - Jose Maria Navarrete Duran
- Health Safety and Emergencies Unit SEAT CUPRA, the Companies of the Volkswagen Group in Spain, 08916 Badalona, Spain;
| | - Albert Tuldrà
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
| | - Maria Sarquella
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
| | - Boris Revollo
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
| | - Josep Maria Llibre
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
| | - Jordi Ara del Rey
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (J.A.d.R.); (O.E.C.)
| | - Oriol Estrada Cuxart
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (J.A.d.R.); (O.E.C.)
| | - Roger Paredes Deirós
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
| | - Guillem Hernández Guillamet
- Central Catalonia Primary Care Directorate, Catalan Institute of Health, Sant Fruitos de Bages, 08272 Barcelona, Spain; (G.H.G.); (J.V.A.)
| | - Bonaventura Clotet Sala
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain; (A.T.); (M.S.); (B.R.); (J.M.L.); (R.P.D.); (B.C.S.)
| | - Josep Vidal Alaball
- Central Catalonia Primary Care Directorate, Catalan Institute of Health, Sant Fruitos de Bages, 08272 Barcelona, Spain; (G.H.G.); (J.V.A.)
- Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Catala de la Salut, Sant Fruitos de Bages, 08272 Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundacio Institut Universitari per a la Recerca a l’Atencio Primaria de Salut Jordi Gol i Gurina, Sant Fruitos de Bages, 08272 Barcelona, Spain
| | - Patricia Such Faro
- Health Safety and Emergencies Unit SEAT CUPRA, the Companies of the Volkswagen Group in Spain, 08916 Badalona, Spain;
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17
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López Seguí F, Estrada Cuxart O, Mitjà i Villar O, Hernández Guillamet G, Prat Gil N, Maria Bonet J, Isnard Blanchar M, Moreno Millan N, Blanco I, Vilar Capella M, Català Sabaté M, Aran Solé A, Argimon Pallàs JM, Clotet B, Ara del Rey J. A Cost-Benefit Analysis of the COVID-19 Asymptomatic Mass Testing Strategy in the North Metropolitan Area of Barcelona. Int J Environ Res Public Health 2021; 18:7028. [PMID: 34209328 PMCID: PMC8297108 DOI: 10.3390/ijerph18137028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The epidemiological situation generated by COVID-19 has highlighted the importance of applying non-pharmacological measures in the management of the epidemic. Mass screening of the asymptomatic general population has been established as a priority strategy by carrying out diagnostic tests to detect possible cases, isolate contacts, cut transmission chains and thus limit the spread of the virus. OBJECTIVE To evaluate the economic impact of mass COVID-19 screenings of an asymptomatic population during the first and second wave of the epidemic in Catalonia, Spain. METHODOLOGY Cost-Benefit Analysis based on the estimated total costs of mass screening versus health gains and associated health costs avoided. RESULTS Excluding the value of monetized health, the Benefit-Cost ratio was estimated at 0.45, a low value that would seem to advise against mass screening policies. However, if monetized health is included, the ratio is close to 1.20, reversing the interpretation. In other words, the monetization of health is the critical element that tips the scales in favour of the desirability of screening. Results show that the interventions with the highest return are those that maximize the percentage of positives detected. CONCLUSION Efficient management of resources for the policy of mass screening in asymptomatic populations can generate high social returns. The positivity rate critically determines its desirability. Likewise, precocity in the detection of cases will cut more transmissions in the chain of contagion and increase the economic return of these interventions. Maximizing the value of resources depends on screening strategies being accompanied by contact-tracing and specific in their focus, targeting, for example, high-risk subpopulations with the highest rate of expected positives.
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Affiliation(s)
- Francesc López Seguí
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority Catalan Institute of Health, 08916 Badalona, Spain;
- Fight AIDS and Infectious Diseases Foundation, 08916 Badalona, Spain;
- Centre de Recerca en Economía de la Salut, Pompeu Fabra University, 08005 Barcelona, Spain;
| | - Oriol Estrada Cuxart
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority Catalan Institute of Health, 08916 Badalona, Spain;
| | | | | | - Núria Prat Gil
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | - Josep Maria Bonet
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | - Mar Isnard Blanchar
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | - Nemesio Moreno Millan
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | - Ignacio Blanco
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | - Marc Vilar Capella
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | - Martí Català Sabaté
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Anna Aran Solé
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
| | | | - Bonaventura Clotet
- IrsiCaixa—Institut de Recerca de La SIDA, Hospital Universitari Germans Trias I Pujol, 08916 Badalona, Spain;
| | - Jordi Ara del Rey
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08916 Badalona, Spain; (N.P.G.); (J.M.B.); (M.I.B.); (N.M.M.); (I.B.); (M.V.C.); (A.A.S.); (J.A.d.R.)
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18
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Solans O, Vidal-Alaball J, Roig Cabo P, Mora N, Coma E, Bonet Simó JM, Hermosilla Pérez E, Saigí-Rubió F, Olmos Domínguez C, Piera-Jiménez J, Abizanda González M, López Seguí F. Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res 2021; 23:e28629. [PMID: 33970867 PMCID: PMC8163495 DOI: 10.2196/28629] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.
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Affiliation(s)
- Oscar Solans
- Health Department, Catalan Ministry of Health, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain.,Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Pasqual Roig Cabo
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Núria Mora
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Josep Maria Bonet Simó
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Eduardo Hermosilla Pérez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.,Jordi Gol i Gurina Primary Health Care Research Institute Foundation, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | | | - Jordi Piera-Jiménez
- Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Mercè Abizanda González
- Health Department, eHealth Unit, Barcelona, Spain.,Pere Virgili Health Park, Primary Care Management Control, Barcelona, Spain
| | - Francesc López Seguí
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain.,Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain
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19
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Marin-Gomez FX, Fàbregas-Escurriola M, Seguí FL, Pérez EH, Camps MB, Peña JM, Comellas AR, Vidal-Alaball J. Assessing the likelihood of contracting COVID-19 disease based on a predictive tree model: A retrospective cohort study. PLoS One 2021; 16:e0247995. [PMID: 33657164 PMCID: PMC7928490 DOI: 10.1371/journal.pone.0247995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Primary care is the major point of access in most health systems in developed countries and therefore for the detection of coronavirus disease 2019 (COVID-19) cases. The quality of its IT systems, together with access to the results of mass screening with Polymerase chain reaction (PCR) tests, makes it possible to analyse the impact of various concurrent factors on the likelihood of contracting the disease. METHODS AND FINDINGS Through data mining techniques with the sociodemographic and clinical variables recorded in patient's medical histories, a decision tree-based logistic regression model has been proposed which analyses the significance of demographic and clinical variables in the probability of having a positive PCR in a sample of 7,314 individuals treated in the Primary Care service of the public health system of Catalonia. The statistical approach to decision tree modelling allows 66.2% of diagnoses of infection by COVID-19 to be classified with a sensitivity of 64.3% and a specificity of 62.5%, with prior contact with a positive case being the primary predictor variable. CONCLUSIONS The use of a classification tree model may be useful in screening for COVID-19 infection. Contact detection is the most reliable variable for detecting Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases. The model would support that, beyond a symptomatic diagnosis, the best way to detect cases would be to engage in contact tracing.
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Affiliation(s)
- Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | - Francesc López Seguí
- Departament de Ciències Experimentals, Grup d’Investigació Economía i Salut, Pompeu Fabra University, Barcelona, Spain
| | - Eduardo Hermosilla Pérez
- Sistema de Informació pel Desenvolupament d’Investigació en Atenció Primària, Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Mència Benítez Camps
- Sistemes d’Informació dels Serveis d’Atenció Primària, Institut Català de la Salut, Barcelona, Spain
- Equip d’atenció Primària Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Departament de Salut, Direcció i Coordinació de la Resposta a la COVID19, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Ruiz Comellas
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Equip d’atenció Primaria Sant Joan de Vilatorrada, Institut Català de la Salut, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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20
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Ahmed W, López Seguí F, Vidal-Alaball J, Katz MS. COVID-19 and the "Film Your Hospital" Conspiracy Theory: Social Network Analysis of Twitter Data. J Med Internet Res 2020; 22:e22374. [PMID: 32936771 PMCID: PMC7537721 DOI: 10.2196/22374] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, a number of conspiracy theories have emerged. A popular theory posits that the pandemic is a hoax and suggests that certain hospitals are "empty." Research has shown that accepting conspiracy theories increases the likelihood that an individual may ignore government advice about social distancing and other public health interventions. Due to the possibility of a second wave and future pandemics, it is important to gain an understanding of the drivers of misinformation and strategies to mitigate it. OBJECTIVE This study set out to evaluate the #FilmYourHospital conspiracy theory on Twitter, attempting to understand the drivers behind it. More specifically, the objectives were to determine which online sources of information were used as evidence to support the theory, the ratio of automated to organic accounts in the network, and what lessons can be learned to mitigate the spread of such a conspiracy theory in the future. METHODS Twitter data related to the #FilmYourHospital hashtag were retrieved and analyzed using social network analysis across a 7-day period from April 13-20, 2020. The data set consisted of 22,785 tweets and 11,333 Twitter users. The Botometer tool was used to identify accounts with a higher probability of being bots. RESULTS The most important drivers of the conspiracy theory are ordinary citizens; one of the most influential accounts is a Brexit supporter. We found that YouTube was the information source most linked to by users. The most retweeted post belonged to a verified Twitter user, indicating that the user may have had more influence on the platform. There was a small number of automated accounts (bots) and deleted accounts within the network. CONCLUSIONS Hashtags using and sharing conspiracy theories can be targeted in an effort to delegitimize content containing misinformation. Social media organizations need to bolster their efforts to label or remove content that contains misinformation. Public health authorities could enlist the assistance of influencers in spreading antinarrative content.
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Affiliation(s)
- Wasim Ahmed
- Department of Marketing, Operations and Systems, Newcastle University Business School, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, United States
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21
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López Seguí F, Walsh S, Solans O, Adroher Mas C, Ferraro G, García-Altés A, García Cuyàs F, Salvador Carulla L, Sagarra Castro M, Vidal-Alaball J. Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study. J Med Internet Res 2020; 22:e19149. [PMID: 32687477 PMCID: PMC7530682 DOI: 10.2196/19149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation service between primary care professionals and citizens in the public health care system, has already reached 1 million cases. Before the COVID-19 pandemic, the use of eConsulta was growing at a monthly rate of 7%, and the growth has been exponential from March 15, 2020 to the present day. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. OBJECTIVE The aim of this study was to annotate a random sample of teleconsultations from eConsulta, and to evaluate the level of agreement between health care professionals with respect to the annotation. METHODS Twenty general practitioners retrospectively annotated a random sample of 5382 cases managed by eConsulta according to three aspects: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. A total of 1217 cases were classified three times by three different professionals to assess the degree of consensus among them. RESULTS The general practitioners considered that 79.60% (4284/5382) of the teleconsultations resulted in avoiding a face-to-face visit, and considered that 64.96% (3496/5382) of the time, the patient would have made a face-to-face visit in the absence of a service like eConsulta. The most frequent uses were for management of test results (26.77%, 1433/5354), management of repeat prescriptions (24.30%, 1301/5354), and medical enquiries (14.23%, 762/5354). The degree of agreement among professionals as to the annotations was mixed, with the highest consensus demonstrated for the question "Has the online consultation avoided a face-to-face visit?" (3/3 professionals agreed 67.95% of the time, 827/1217), and the lowest consensus for the type of use of the teleconsultation (3/3 professionals agreed 57.60% of the time, 701/1217). CONCLUSIONS This study shows the ability of eConsulta to reduce the number of face-to-face visits for 55% (79% × 65%) to 79% of cases. In comparison to previous research, these results are slightly more pessimistic, although the rates are still high and in line with administrative data proxies, showing that 84% of patients using teleconsultations do not make an in-person appointment in the following 3 months. With respect to the type of consultation performed, our results are similar to the existing literature, thus providing robust support for eConsulta's usage. The mixed degree of consensus among professionals implies that results derived from artificial intelligence tools such as message classification algorithms should be interpreted in light of these shortcomings.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Spain.,Centre de Recerca en Economía de la Salut, Pompeu Fabra University, Barcelona, Spain
| | - Sandra Walsh
- Institut de Biologia Evolutiva (CSIC), Pompeu Fabra University, Barcelona, Spain
| | - Oscar Solans
- Health Department, Catalan Ministry of Health, Barcelona, Spain
| | | | | | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia, Catalan Ministry of Health, Barcelona, Spain
| | | | - Luis Salvador Carulla
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Marta Sagarra Castro
- Centre d'Atenció Primària Capellades, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
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22
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Vidal-Alaball J, Acosta-Roja R, Pastor Hernández N, Sanchez Luque U, Morrison D, Narejos Pérez S, Perez-Llano J, Salvador Vèrges A, López Seguí F. Telemedicine in the face of the COVID-19 pandemic. Aten Primaria 2020; 52:418-422. [PMID: 32402477 PMCID: PMC7164871 DOI: 10.1016/j.aprim.2020.04.003] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 is a positive single-stranded RNA virus that can be immediately translated and integrated into the host cell with its own RNA messenger, facilitating replication inside the cell and infectivity. The rapid progression of the disease presents a real challenge for the whole world. As the usual capacity for citizen care is exceeded, health professionals and governments struggle. One of the most important strategies to reduce and mitigate the advance of the epidemic are social distance measures; this is where telemedicine can help, and provide support to the healthcare systems, especially in the areas of public health, prevention and clinical practices, just as it is doing in others sectors. Telemedicine connects the convenience, low cost, and ready accessibility of health-related information and communication using the Internet and associated technologies. Telemedicine during the coronavirus epidemic has been the doctors' first line of defense to slow the spread of the coronavirus, keeping social distancing and providing services by phone or videoconferencing for mild to focus personal care and limited supplies to the most urgent cases.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Foundation for Research in Primary Health Care Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Ruthy Acosta-Roja
- EBA Centelles, Barcelona, Spain; Digital Care Research Group, University of Vic-UCC, Barcelona, Spain
| | | | | | - Danielle Morrison
- HumanITcare, SME Technology Company, Barcelona, Spain; North Carolina State University, USA
| | - Silvia Narejos Pérez
- EBA Centelles, Barcelona, Spain; Digital Care Research Group, University of Vic-UCC, Barcelona, Spain; Grup Innovació ACEBA, Barcelona, Spain
| | | | - Angels Salvador Vèrges
- Digital Care Research Group, University of Vic-UCC, Barcelona, Spain; Iberian Society of Telehealth and Telemedicine.
| | - Francesc López Seguí
- TIC Salut Social - Ministry of Health, CRES&CEXS - Pompeu Fabra University, Barcelona, Spain
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Ahmed W, Vidal-Alaball J, Downing J, López Seguí F. COVID-19 and the 5G Conspiracy Theory: Social Network Analysis of Twitter Data. J Med Internet Res 2020; 22:e19458. [PMID: 32352383 PMCID: PMC7205032 DOI: 10.2196/19458] [Citation(s) in RCA: 278] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 01/22/2023] Open
Abstract
Background Since the beginning of December 2019, the coronavirus disease (COVID-19) has spread rapidly around the world, which has led to increased discussions across online platforms. These conversations have also included various conspiracies shared by social media users. Amongst them, a popular theory has linked 5G to the spread of COVID-19, leading to misinformation and the burning of 5G towers in the United Kingdom. The understanding of the drivers of fake news and quick policies oriented to isolate and rebate misinformation are keys to combating it. Objective The aim of this study is to develop an understanding of the drivers of the 5G COVID-19 conspiracy theory and strategies to deal with such misinformation. Methods This paper performs a social network analysis and content analysis of Twitter data from a 7-day period (Friday, March 27, 2020, to Saturday, April 4, 2020) in which the #5GCoronavirus hashtag was trending on Twitter in the United Kingdom. Influential users were analyzed through social network graph clusters. The size of the nodes were ranked by their betweenness centrality score, and the graph’s vertices were grouped by cluster using the Clauset-Newman-Moore algorithm. The topics and web sources used were also examined. Results Social network analysis identified that the two largest network structures consisted of an isolates group and a broadcast group. The analysis also revealed that there was a lack of an authority figure who was actively combating such misinformation. Content analysis revealed that, of 233 sample tweets, 34.8% (n=81) contained views that 5G and COVID-19 were linked, 32.2% (n=75) denounced the conspiracy theory, and 33.0% (n=77) were general tweets not expressing any personal views or opinions. Thus, 65.2% (n=152) of tweets derived from nonconspiracy theory supporters, which suggests that, although the topic attracted high volume, only a handful of users genuinely believed the conspiracy.
This paper also shows that fake news websites were the most popular web source shared by users; although, YouTube videos were also shared. The study also identified an account whose sole aim was to spread the conspiracy theory on Twitter. Conclusions The combination of quick and targeted interventions oriented to delegitimize the sources of fake information is key to reducing their impact. Those users voicing their views against the conspiracy theory, link baiting, or sharing humorous tweets inadvertently raised the profile of the topic, suggesting that policymakers should insist in the efforts of isolating opinions that are based on fake news. Many social media platforms provide users with the ability to report inappropriate content, which should be used. This study is the first to analyze the 5G conspiracy theory in the context of COVID-19 on Twitter offering practical guidance to health authorities in how, in the context of a pandemic, rumors may be combated in the future.
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Affiliation(s)
- Wasim Ahmed
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Joseph Downing
- London School of Economics, European Institute, London, United Kingdom
| | - Francesc López Seguí
- TIC Salut Social, Generalitat de Catalunya, Barcelona, Spain.,CRES & CEXS, Universitat Pompeu Fabra, Barcelona, Spain
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López Seguí F, Batlle Boada A, García García JJ, López Ulldemolins A, Achotegui Del Arco A, Adroher Mas C, García Cuyàs F. Families' Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia. JMIR Pediatr Parent 2020; 3:e17517. [PMID: 32213471 PMCID: PMC7146252 DOI: 10.2196/17517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children's care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. OBJECTIVE This study aimed to assess families' degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. METHODS A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children's characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. RESULTS A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. CONCLUSIONS Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Spain.,Centre for Research in Health and Economics, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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López Seguí F, Franch Parella J, Gironès García X, Mendioroz Peña J, García Cuyàs F, Adroher Mas C, García-Altés A, Vidal-Alaball J. A Cost-Minimization Analysis of a Medical Record-based, Store and Forward and Provider-to-provider Telemedicine Compared to Usual Care in Catalonia: More Agile and Efficient, Especially for Users. Int J Environ Res Public Health 2020; 17:ijerph17062008. [PMID: 32197434 PMCID: PMC7143363 DOI: 10.3390/ijerph17062008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011, specializing in teledermatology, teleulcers, teleophthalmology and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits were recorded. Objective: To analyze the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user’s costs, was carried out over a three-month period. Results: Telemedicine saved € 780,397 over the period analyzed. A differential cost favorable to telemedicine of about € 15 per visit was observed, with the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Allowing users to save time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favorable for the healthcare system, enabling it to provide a more agile service, which also benefits healthcare professionals.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Catalan Ministry of Health, 08005 Barcelona, Spain;
- CRES&CEXS, Pompeu Fabra University, 08003 Barcelona, Spain
| | - Jordi Franch Parella
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain; (J.F.P.); (X.G.G.)
| | - Xavier Gironès García
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain; (J.F.P.); (X.G.G.)
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
| | - Francesc García Cuyàs
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain; (F.G.C.); (C.A.M.)
| | - Cristina Adroher Mas
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain; (F.G.C.); (C.A.M.)
| | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, 08003 Barcelona, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
- Correspondence:
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López Seguí F, Vidal-Alaball J, Sagarra Castro M, García-Altés A, García Cuyàs F. General Practitioners' Perceptions of Whether Teleconsultations Reduce the Number of Face-to-face Visits in the Catalan Public Primary Care System: Retrospective Cross-Sectional Study. J Med Internet Res 2020; 22:e14478. [PMID: 32175914 PMCID: PMC7105927 DOI: 10.2196/14478] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/09/2019] [Accepted: 02/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND eConsulta is a teleconsultation service involving general practitioners (GPs) and patients. It is part of the information system belonging to Catalonia's primary care service. It has been in operation since the end of 2015 in conjunction with face-to-face consultations with Primary Care Teams as one of the services offered in the patient's Personal Health Folder. OBJECTIVE This study aimed to assess the ability of using eConsulta to reduce the number of face-to-face visits to Primary Care Teams. METHODS Using 13 categories proposed by the researchers, 18 GPs from the Central Catalonia Health Region retrospectively classified 2268 cases managed with eConsulta and indicated whether, in their opinion, the teleconsultations reduced the number of face-to-face visits. RESULTS There was broad consensus among the GPs that eConsulta has the potential to resolve patient queries for every type of consultation. eConsulta avoided the need for a face-to-face visit in 87.9% of cases. In addition, the GPs reported that the ease of access increased the demand for health care support in 27.7% of cases; otherwise, the patient would not have initiated the queries. Therefore, based on the equation (88% x [1-28%]), eConsulta could replace 63%-88% of conventional appointments. The most frequent uses of the teleconsultation service were for management of test results (35.2%), medical enquiries (16.0%), and the management of repeat prescriptions (12.2%). On average, the teleconsultations consisted of a mean 1.57 messages (SD 0.54 messages); 45.9% (1040/2268) of the teleconsultations consisted of 1 message, and the majority of the remaining teleconsultations consisted of 2-5 interactions. The patient initiated 60.0% (1361/2268) of the teleconsultations. CONCLUSIONS Based on the GPs' perceptions, eConsulta could replace 63%-88% of conventional appointments. Therefore, asynchronous teleconsultations between practitioners and patients in primary care could avoid interactions that have limited added clinical value.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Spain.,Centre for Research in Health and Economics, Pompeu Fabra University, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Marta Sagarra Castro
- Centre d'Atenció Primària Capellades, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Anna García-Altés
- Centre for Research in Health and Economics, Pompeu Fabra University, Barcelona, Spain.,Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, Barcelona, Spain
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López Seguí F, Ander Egg Aguilar R, de Maeztu G, García-Altés A, García Cuyàs F, Walsh S, Sagarra Castro M, Vidal-Alaball J. Teleconsultations between Patients and Healthcare Professionals in Primary Care in Catalonia: The Evaluation of Text Classification Algorithms Using Supervised Machine Learning. Int J Environ Res Public Health 2020; 17:E1093. [PMID: 32050435 PMCID: PMC7036927 DOI: 10.3390/ijerph17031093] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 11/16/2022]
Abstract
Background: The primary care service in Catalonia has operated an asynchronous teleconsulting service between GPs and patients since 2015 (eConsulta), which has generated some 500,000 messages. New developments in big data analysis tools, particularly those involving natural language, can be used to accurately and systematically evaluate the impact of the service. Objective: The study was intended to assess the predictive potential of eConsulta messages through different combinations of vector representation of text and machine learning algorithms and to evaluate their performance. Methodology: Twenty machine learning algorithms (based on five types of algorithms and four text representation techniques) were trained using a sample of 3559 messages (169,102 words) corresponding to 2268 teleconsultations (1.57 messages per teleconsultation) in order to predict the three variables of interest (avoiding the need for a face-to-face visit, increased demand and type of use of the teleconsultation). The performance of the various combinations was measured in terms of precision, sensitivity, F-value and the ROC curve. Results: The best-trained algorithms are generally effective, proving themselves to be more robust when approximating the two binary variables "avoiding the need of a face-to-face visit" and "increased demand" (precision = 0.98 and 0.97, respectively) rather than the variable "type of query" (precision = 0.48). Conclusion: To the best of our knowledge, this study is the first to investigate a machine learning strategy for text classification using primary care teleconsultation datasets. The study illustrates the possible capacities of text analysis using artificial intelligence. The development of a robust text classification tool could be feasible by validating it with more data, making it potentially more useful for decision support for health professionals.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social—Ministry of Health, 08028 Barcelona, Spain;
- CRES&CEXS—Pompeu Fabra University, 08003 Barcelona, Spain
| | | | | | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, 08005 Barcelona, Spain;
| | | | - Sandra Walsh
- Institut de Biologia Evolutiva (UPF-CSIC), Pompeu Fabra University, 08003 Barcelona, Spain;
| | - Marta Sagarra Castro
- Centre d’Atenció Primària Capellades, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08786 Sant Fruitós de Bages, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
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Fernández OS, Seguí FL, Vidal-Alaball J, Bonet Simo JM, Vian OH, Cabo PR, Hernandez MC, Dominguez CO, Reig XA, Rodríguez YD, Peralta MM, Hermosilla E, León NM, Guimferrer N, González MA, Cuyàs FG, Sust PP. Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study. JMIR Med Inform 2020; 8:e16484. [PMID: 32012061 PMCID: PMC7055836 DOI: 10.2196/16484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND eConsulta is a tele-consultation service involving doctors and patients, and is part of Catalonia's public health information technology system. The service has been in operation since the end of 2015 as an adjunct to face-to-face consultations. A key factor in understanding the barriers and facilitators to the acceptance of the tool is understanding the sociodemographic characteristics of general practitioners who determine its use. OBJECTIVE This study aimed to analyze the sociodemographic factors that affect the likelihood of doctors using eConsulta. METHODS A retrospective cross-sectional analysis of administrative data was used to perform a multivariate logistic regression analysis on the use of eConsulta in relation to sociodemographic variables. RESULTS The model shows that the doctors who use eConsulta are 45-54 years of age, score higher than the 80th percentile on the quality of care index, have a high degree of accessibility, are involved in teaching, and work on a health team in a high socioeconomic urban setting. CONCLUSIONS The results suggest that certain sociodemographic characteristics associated with general practitioners determine whether they use eConsulta. These results must be taken into account if its deployment is to be encouraged in the context of a public health system.
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Affiliation(s)
| | - Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Catalonia, Spain
- Center for Research in Health and Economics, Pompeu Fabra University, Barcelona, Catalonia, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Catalonia, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Catalonia, Spain
| | | | | | - Pascual Roig Cabo
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
| | - Marta Carrasco Hernandez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | | | - Xavier Alzaga Reig
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
| | - Yesika Díaz Rodríguez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | - Manuel Medina Peralta
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | - Eduardo Hermosilla
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Catalonia, Spain
| | | | - Nuria Guimferrer
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
| | | | | | - Pol Pérez Sust
- Health Department, Catalan Ministry of Health, Barcelona, Catalonia, Spain
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López Seguí F, de San Pedro M, Aumatell Verges E, Simó Algado S, Garcia Cuyàs F. An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation. JMIR Aging 2019; 2:e13939. [PMID: 31518276 PMCID: PMC6746070 DOI: 10.2196/13939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/12/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND "Digital Partners" is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users' digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. OBJECTIVE The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. METHODS Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants' satisfaction. RESULTS The experience shows a broad satisfaction of both junior and senior users. The project's strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals' free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project's duration, if necessary. CONCLUSIONS This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Generalitat de Catalunya, Mataró, Spain
- Centre for Research in Health and Economics, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | - Francesc Garcia Cuyàs
- Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
- Sant Joan de Déu Hospital, Barcelona, Spain
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Salvador Verges À, Fernández-Luque L, López Seguí F, Yildirim M, Salvador-Mata B, García Cuyàs F. Orthopedic Surgeons' Perspectives on the Decision-Making Process for the Use of Bioprinter Cartilage Grafts: Web-Based Survey. Interact J Med Res 2019; 8:e14028. [PMID: 31094326 PMCID: PMC6540724 DOI: 10.2196/14028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Traumatic and degenerative lesions in the cartilage are one of the most difficult and frustrating types of injuries for orthopedic surgeons and patients. Future developments in medical science, regenerative medicine, and materials science may allow the repair of human body parts using 3D bioprinting techniques and serve as a basis for new therapies for tissue and organ regeneration. One future possibility is the treatment of joint cartilage defects with in vivo 3D printing from biological/biocompatible materials to produce a suitable cell attachment and proliferation environment in the damaged site and employ the natural recovery potential of the body. This study focuses on the perspectives of orthopedic surgeons regarding the key factors/determinants and perceived clinical value of a new therapeutic option. OBJECTIVE This study aimed to determine the knowledge and expectations of orthopedic surgeons regarding the clinical use of bioprinted cartilage. METHODS The survey, conducted anonymously and self-managed, was sent to orthopedic surgeons from the Catalan Society of Orthopedic and Traumatology Surgery. In accordance with the method devised by Eysenbach, the Checklist for Reporting Results of Internet E-Surveys was used to analyze the results. The following factors were taken into consideration: the type and origin of the information received; its relevance; the level of acceptance of new technologies; and how the technology is related to age, years, and place of experience in the field. RESULTS Of the 86 orthopedic surgeons included, 36 believed the age of the patient was a restriction, 53 believed the size of the lesion should be between 1 and 2 cm to be considered for this type of technology, and 51 believed that the graft should last more than 5 years. Surgeons over 50 years of age (38/86, 44%) gave more importance to clinical evidence as compared to surgeons from the other age groups. CONCLUSIONS The perspective of orthopedic surgeons depends highly on the information they receive and whether it is specialized and consistent, as this will condition their acceptance and implementation of the bioprinted cartilage.
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Affiliation(s)
- Àngels Salvador Verges
- Digital Care Research Group, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
| | | | - Francesc López Seguí
- TIC Salut Social, Generalitat de Catalunya, Mataro, Barcelona, Spain
- Department of Experimental and Health Sciences, Centre for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Meltem Yildirim
- Centre for Health and Social Care Research, Faculty of Health Science and Welfare, Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences, Vic, Spain
| | | | - Francesc García Cuyàs
- Hospital Sant Joan de Déu, Digital Care Research Group, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
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López Seguí F, Pratdepàdua Bufill C, Rius Soler A, de San Pedro M, López Truño B, Aguiló Laine A, Martínez Roldán J, García Cuyàs F. Prescription and Integration of Accredited Mobile Apps in Catalan Health and Social Care: Protocol for the AppSalut Site Design. JMIR Res Protoc 2018; 7:e11414. [PMID: 30578234 PMCID: PMC6320420 DOI: 10.2196/11414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
Background The use of new mobile technologies in the health and social welfare sectors is already a reality. The ICT Social Health Foundation, in accordance with the technology strategy of the Catalan government’s Ministry of Health and its Ministry of Labour, Social Affairs and Families, is leading an initiative to create a public library of apps for its AppSalut Site. Objective The objective of this paper is to present an account of the design of the project, with a global perspective, applied to the Catalan ecosystem, which can be divided into 3 areas: the framework governing the recommendation and prescription of apps, the subset of interoperability for mobile environments, and the data storage infrastructure. Methods The security and credibility of the apps included in the catalog is ensured by submitting them to an accreditation process in the public domain that provides users with the guarantee that they are fit for purpose and trustworthy for the management and care of their health, while providing health care professionals with the possibility of recommending the apps in the doctor’s surgery, as well as adding the information generated by the users’ mobile devices to the information systems of the various organizations concerned. Results An examination of the abovementioned areas suggests possibilities for improvements in the future. The experience obtained from the development of this element has shown the heterogeneity of the vocabularies used, as expected, due to the lack of awareness on the part of the developers regarding the need to standardize the information generated by the app, requiring the foundation to take on the role of consultant. Conclusions The project has evolved in keeping with changes in the technological and social paradigm and responds very satisfactorily to the needs posed to it. It can be seen as a landmark experience in mobile strategies in the fields of health and welfare of any public health system. The experience has shown itself to be feasible in organizational terms, necessary in any attempt to integrate mobile technologies into public health practice, and a global pioneer in the field. International Registered Report Identifier (IRRID) RR1-10.2196/11414
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Generalitat de Catalunya, Mataró, Spain.,Centre for Research in Health and Economics, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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