Project INTEGRATE: Developing a framework to guide design, implementation and evaluation of people-centred integrated care processes

Background: People-centred integrated care is an acknowledged approach to improve the quality and effectiveness of health systems in delivering care around people’s needs and preferences. Nevertheless, more guidance on how to effectively design, implement and evaluate the care process of people-centred integrated care services is needed. Under Project INTEGRATE, a framework was developed to guide managers in the assessment, transformation and delivery of these health service innovations. Methods: The framework is a product of the synthesis of operations, service and project management literature, relevant health care literature, and the analysis of four good practice integrated care case studies analysed under Project INTEGRATE. A first iteration of the framework was developed and then applied to one of the integrated care case studies to test its validity and utility. Results and Discussion: The tool combines a number of important considerations and criteria that have not been previously included in integrated care assessment frameworks, allowing for a pragmatic and comprehensive analysis of the care process. Conclusion: This framework can be used as a stand-alone or combined tool to guide managers to plan and evaluate the care process design of people-centred integrated care services; future work should apply this tool to other settings

Project INTEGRATE: Developing a Framework to Guide Design, Implementation and Evaluation of People-centred Integrated Care Processes

Background: People-centred integrated care is an acknowledged approach to improve the quality and effectiveness of health systems in delivering care around people’s needs and preferences. Nevertheless, more guidance on how to effectively design, implement and evaluate the care process of people-centred integrated care services is needed. Under Project INTEGRATE, a framework was developed to guide managers in the assessment, transformation and delivery of these health service innovations. Methods: The framework is a product of the synthesis of operations, service and project management literature, relevant health care literature, and the analysis of four good practice integrated care case studies analysed under Project INTEGRATE. A first iteration of the framework was developed and then applied to one of the integrated care case studies to test its validity and utility. Results and Discussion: The tool combines a number of important considerations and criteria that have not been previously included in integrated care assessment frameworks, allowing for a pragmatic and comprehensive analysis of the care process. Conclusion: This framework can be used as a stand-alone or combined tool to guide managers to plan and evaluate the care process design of people-centred integrated care services; future work should apply this tool to other settings

Deaths of Despair: A Scoping Review on the Social Determinants of Drug Overdose, Alcohol-Related Liver Disease and Suicide

Death of despair; Health inequalities; Public healthMuerte de desesperación; Desigualdades en salud; Salud públicaMort de desesperació; Desigualtats en salut; Salut públicaBackground: There is a lack of consensus on the social determinants of Deaths of Despair (DoD), i.e., an increase in mortality attributed to drug overdose, alcohol-related liver disease, and suicide in the United States (USA) during recent years. The objective of this study was to review the scientific literature on DoD with the purpose of identifying relevant social determinants and inequalities related to these mortality trends. Methods: Scoping review focusing on the period 2015–2022 based on PubMed search. Articles were selected according to the following inclusion criteria: published between 1 January 2000 and 31 October 2021; including empirical data; analyzed DoD including the three causes defined by Case and Deaton; analyzed at least one social determinant; written in English; and studied DoD in the USA context only. Studies were excluded if they only analyzed adolescent populations. We synthesized our findings in a narrative report specifically addressing DoD by economic conditions, occupational hazards, educational level, geographical setting, and race/ethnicity. Results: Seventeen studies were included. Overall, findings identify a progressive increase in deaths attributable to suicide, drug overdose, and alcohol-related liver disease in the USA in the last two decades. The literature concerning DoD and social determinants is relatively scarce and some determinants have been barely studied. However different, however, large inequalities have been identified in the manner in which the causes of death embedded in the concept of DoD affect different subpopulations, particularly African American, and Hispanic populations, but blue collar-whites are also significantly impacted. Low socioeconomic position and education levels and working in jobs with high insecurity, unemployment, and living in rural areas were identified as the most relevant social determinants of DoD. Conclusions: There is a need for further research on the structural and intermediate social determinants of DoD and social mechanisms. Intersectional and systemic approaches are needed to better understand and tackle DoD and related inequalities

Key epidemiological indicators and spatial autocorrelation patterns across five waves of COVID-19 in Catalonia

This research studies the evolution of COVID-19 crude incident rates, effective reproduction number R(t) and their relationship with incidence spatial autocorrelation patterns in the 19 months following the disease outbreak in Catalonia (Spain). A cross-sectional ecological panel design based on n = 371 health-care geographical units is used. Five general outbreaks are described, systematically preceded by generalized values of R(t) > 1 in the two previous weeks. No clear regularities concerning possible initial focus appear when comparing waves. As for autocorrelation, we identify a wave’s baseline pattern in which global Moran’s I increases rapidly in the first weeks of the outbreak to descend later. However, some waves significantly depart from the baseline. In the simulations, both baseline pattern and departures can be reproduced when measures aimed at reducing mobility and virus transmissibility are introduced. Spatial autocorrelation is inherently contingent on the outbreak phase and is also substantially modified by external interventions affecting human behavior

Medicina de Precisión y Ensayos Clínicos.

Sesión 2.Elementos críticos en la implantación de la Medicina de Precisión.Drug development — Challenges.Drug development— Novel ways forward.Diferent trial approaches.Strategic Public-Private Alliance. Develop Integrated Research Platform (IRP). EU-PEARL IRP Concept.What will EU-PEARL deliver?N

Where, why and how scientific knowledge on health inequalities is generated? : An integrated perspective to strengthen understanding of health inequalities research capacities : Key insights from the United Kingdom and the city of Barcelona

This dissertation aims to understand where, why and how scientific knowledge on health inequalities is produced, why and how some places have strong capacity to produce this, and what determines this capacity. It consists of five main research articles, which integrate diverse disciplinary perspectives and methods (e.g. bibliometric and network analyses; critical review, realist explanatory case studies, with semi-structured interviews and data triangulation). Results found significant inequalities within the health inequalities scientific research field, and propose a global hypothesis on the health inequalities research production process at the local/national level, and some of the potenital conditions, determinants and dynamics involved. In the case of the United Kingdom, and the city of Barcelona, evidence suggests that six causal mechanisms, when activated under certain conditions, are key contributors to the generation of a high volume of health inequalities research. Further research should confirm and analyse them in other settings.Esta disertación tiene como objetivo comprender dónde, por qué y cómo se produce el conocimiento científico sobre desigualdades en salud, e identificar qué determina la capacidad para crear este conocimiento en distintos contextos. Incluye cinco artículos de investigación que integran diversas perspectivas y métodos (análisis bibliométricos y de redes; revisión crítica; estudios de casos explicativos realistas; entrevistas semiestructuradas; y triangulación de datos). Los resultados principales señalan importantes desigualdades en la producción de conocimiento científico en desigualdades en salud a nivel global; se plantea una hipótesis global sobre dicho proceso y los principales determinantes, dinámicas y condiciones implicados a nivel local o nacional; en el caso del Reino Unido y Barcelona, ​​la evidencia sugiere que seis mecanismos causales han contribuido a la generación de un alto volumen de investigación sobre desigualdades en salud, los cuales se activan bajo ciertas condiciones. Investigaciones futuras deberán analizar dichos mecanismos y determinantes en distintos entornos

Project INTEGRATE - a common methodological approach to understand integrated health care in Europe

Background: The use of case studies in health services research has proven to be an excellent methodology for gaining in-depth understanding of the organisation and delivery of health care. This is particularly relevant when looking at the complexity of integrated healthcare programmes, where multifaceted interactions occur at the different levels of care and often without a clear link between the interventions (new and/or existing) and their impact on outcomes (in terms of patients health, both patient and professional satisfaction and cost-effectiveness). Still, integrated care is seen as a core strategy in the sustainability of health and care provision in most societies in Europe and beyond. More specifically, at present, there is neither clear evidence on transferable factors of integrated care success nor a method for determining how to establish these specific success factors. The drawback of case methodology in this case, however, is that the in-depth results or lessons generated are usually highly context-specific and thus brings the challenge of transferability of findings to other settings, as different health care systems and different indications are often not comparable. Project INTEGRATE, a European Commission-funded project, has been designed to overcome these problems; it looks into four chronic conditions in different European settings, under a common methodology framework (taking a mixed-methods approach) to try to overcome the issue of context specificity and limited transferability. The common methodological framework described in this paper seeks to bring together the different case study findings in a way that key lessons may be derived and transferred between countries, contexts and patient-groups, where integrated care is delivered in order to provide insight into generalisability and build on existing evidence in this field.Methodology: To compare the different integrated care experiences, a mixed-methods approach has been adopted with the creation of a common methodological framework (including data collection tools and case study template report) to be used by the case studies for their analyses.Methods of analysis: The four case studies attempt to compare health care services before and after the ‘integration’ of care, while triangulating the findings using quantitative and qualitative data, and provide an in-depth description of the organisation and delivery of care, and the impact on outcomes. The common framework aims to allow for the extraction of key transferable learning from the cases, taking into account context-dependency.Conclusion: The application and evaluation of the common methodological approach aim to distill and identify important elements for successful integrated care, in order to strengthen the evidence base for integrated care (by facilitating cross-context comparisons), increase the transferability of findings from highly context-specific to other settings and lead to concrete and practical policy and operational recommendations

Why and how has the United Kingdom become a high producer of health inequalities research over the past 50 years? A realist explanatory case study

Background: Evidence on health inequalities has been growing over the past few decades, yet the capacity to produce research on health inequalities varies between countries worldwide and needs to be strengthened. More indepth understanding of the sociohistorical, political and institutional processes that enable this type of research and related research capacity to be generated in diferent contexts is needed. A recent bibliometric analysis of the health inequalities research feld found inequalities in the global production of this type of research. It also found the United Kingdom to be the second-highest global contributor to this research feld after the United States. This study aims to understand why and how the United Kingdom, as an example of a “high producer” of health inequalities research, has been able to generate so much health inequalities research over the past fve decades, and which main mechanisms might have been involved in generating this specifc research capacity over time. Methods: We conducted a realist explanatory case study, which included 12 semi-structured interviews, to test six theoretical mechanisms that we proposed might have been involved in this process. Data from the interviews and grey and scientifc literature were triangulated to inform our fndings. Results: We found evidence to suggest that at least four of our proposed mechanisms have been activated by certain conditions and have contributed to the health inequalities research production process in the United Kingdom over the past 50 years. Limited evidence suggests that two new mechanisms might have potentially also been at play. Conclusions: Valuable learning can be established from this case study, which explores the United Kingdom’s experi‑ ence in developing a strong national health inequalities research tradition, and the potential mechanisms involved in this process. More research is needed to explore additional facilitating and inhibiting mechanisms and other factors involved in this process in this context, as well as in other settings where less health inequalities research has been produced. This type of in-depth knowledge could be used to guide the development of new health inequalities research capacity-strengthening strategies and support the development of novel approaches and solutions aiming to tackle health inequalities