Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols

Background: Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016–2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011–2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). Methods: The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. Discussion: The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection.publishedVersio

Effects of Language Context on Ratings of Shy and Unsociable Behaviors in English Language Learning Children

Purpose The primary goal of this study was to explore the effect of the language context on the socially withdrawn behaviors of school aged-children who are English Language Learners (ELLs) from middle to high SES backgrounds. This is one of the first studies to address the frequently confused concepts of shyness and unsociability as independent constructs within the ELL population. This study also investigated the feasibility of an experimental parent and child questionnaire that examines shyness and unsociability across native and English speaking contexts. Method Children and parents (34 ELL and 37 native English speaking) were administered an experimental questionnaire examining shy and unsociable behavior in native language and English-speaking contexts. Results Parents and children from the ELL group reported significantly higher ratings of shy behavior in English versus native language contexts, whereas unsociable ratings did not differ across language contexts. Conclusions Shyness and unsociability are distinguishable behaviors in ELL children and these constructs should be considered when examining withdrawal. Additionally, examining ELL children’s behavior across language contexts provides a valuable method for investigating language influenced behavioral problems. This study demonstrates the need for service providers to evaluate behavior across subtype and language context before pathologizing withdrawal in ELL children

Pedantic speaking style differentiates asperger syndrome from high-functioning autism

Asperger syndrome (AS) is a pervasive developmental disorder recently introduced as a new diagnostic category in the ICD-10 and the DSM-IV. Along with motor clumsiness, pedantic speech has been proposed as a clinical feature of AS. However, few attempts have been made to define and measure this symptom. We studied 17 patients with AS (ICD-10; 14 male, 3 female; mean age 16.4 years, mean full-scale IQ 97) and compared them with a control group of 13 patients with normal-intelligence autism or high-functioning autism (HFA) (ICD-10/DSM-III-R; 12 male, 1 female; mean age 15.5 years, mean full-scale IQ 81.2). An operational definition of pedantic speech was formulated and a rating scale devised. 13 (76%) of the AS patients were rated as pedantic compared to 4 (31%) of the HFA group (χ 2 =6.3; p = .01). Results suggest that pedantic speech is common in AS and may help differentiate AS from high-functioning autism .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44615/1/10803_2005_Article_BF02172348.pd

Evaluation of integrated care services in Catalonia: Population-based and service-based real-life deployment protocols

Background: Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (52