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dc.contributor.authorBerntsen, Gro Karine Rosvold
dc.contributor.authorStrisland, Frode
dc.contributor.authorMalm-Nicolaisen, Kristian
dc.contributor.authorSmaradottir, Berglind
dc.contributor.authorFensli, Rune Werner
dc.contributor.authorRøhne, Mette
dc.date.accessioned2019-08-09T07:15:35Z
dc.date.available2019-08-09T07:15:35Z
dc.date.issued2019-04-22
dc.description.abstract<i>Background</i>: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored.<p> <p><i>Objective</i>: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes.<p> <p><i>Methods</i>: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects.<p> <p><i>Results</i>: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects.<p> <p><i>Conclusions</i>: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support.en_US
dc.description.sponsorshipThe Norwegian Centre for E-health Researchen_US
dc.descriptionSource at <a href=https://doi.org/10.2196/12517>https://doi.org/10.2196/12517. </a>en_US
dc.identifier.citationBerntsen, G., Strisland, F., Malm-Nicolaisen, K., Smaradottir, B., Fensli, R. & Røhne, M. (2019). The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review. <i>Journal of Medical Internet Research, 21</i>(4):e12517. https://doi.org/10.2196/12517en_US
dc.identifier.cristinIDFRIDAID 1702871
dc.identifier.doi10.2196/12517
dc.identifier.issn1438-8871
dc.identifier.urihttps://hdl.handle.net/10037/15881
dc.language.isoengen_US
dc.publisherJournal of Medical Internet Researchen_US
dc.relation.journalJournal of Medical Internet Research
dc.relation.projectIDinfo:eu-repo/grantAgreement/RCN/HELSE-EU/269884/Norway/e-helseløsninger for personsentrerte, helhetlige og proaktive hjemmeoppfølgingstjenester for personer med kronisk sykdom og langvarige behov//en_US
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801en_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801en_US
dc.subjectSystematic reviewen_US
dc.subjectpatient-centered careen_US
dc.subjectdelivery of health careen_US
dc.subjectintegrateden_US
dc.subjectsecondary preventionen_US
dc.subjectrisk managementen_US
dc.titleThe Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Reviewen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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