The network
research programme
03
WP 8. To evaluate primary care services and care continuity in response to chronic diseases.
Coordinator
Enrique Bernal
Research Group in Data researchRD24/0005/0014Participating Groups
CARDIOCAT. IP:
Rafel Ramos (RD24/0005/0001)
RicappsAragon-IACS. IP:
Enrique Bernal (RD24/0005/0014)
Ricapps
Canary Islands. IP:
Lilisbeth Perestelo (RD24/0005/0003)
Ricapps
EpiChron. IP:
Antonio Gimeno (RD24/0005/0013)
Ricapps
H. Costa del Sol. IP:
Maximino Redondo (RD24/0005/0016)
Ricapps
GRENSSAP. IP:
Anna Berenguera (RD24/0005/0005)
Ricapps
Biosistemak - OSI Bilbao-Basurto. IP:
Amaia Bilbao (RD24/0005/0019)
Ricapps
Biosistemak - OSI Barrualde-Galdakao. IP:
Susana García (RD24/0005/0020)
Ricapps
Madrid. IP:
Isabel del Cura (RD24/0005/0015)
Ricapps
Navarra. IP:
Berta Ibáñez (RD24/0005/0024)
RicappsValencia. IP:
Isabel Hurtado (RD24/0005/0009)
RicappsFAD. IP:
Carola Orrego (RD24/0005/0025)
RicappsResearch lines
Line 1 Characterising services and policies developed or implemented to tackle chronic and fragile patients’ needs and improve their health outcomes.
Task 1. Characterise how patients and professionals perceive patients’ navigation across the health services.
Task 2. Determine what attributes of primary care may have an impact in the improvement of population health outcomes.
Task 3. Determine the needs of primary care professionals and their territorial distribution.
Line 2 Identifying, analysing, and monitoring of unwarranted variations in the care provided to chronic and fragile patients.
Task 1. Annually updating (2025, 2026, 2027) of the Atlas of Potentially Avoidable Hospitalizations in Chronic conditions and fragile patients at primary care and health care area levels.
Task 2. Annually updating (2025, 2026, 2027) of the Atlas of Diabetes care.
Task 3. Annually updating (2025, 2026, 2027) of the Atlas of Cardiovascular care.
Task 4. Annually updating (2025, 2026, 2027) of the Atlas of Safe Pharmaceutical care.
Line 3 Evaluating the effectiveness and efficiency of care continuity in various patients’ cohort
Task 1. Carrying out cross-regional federated analyses of outcomes and costs in diabetes care continuity (CONCEPT-Diabetes).
Task 2. Carrying out cross-regional federated analyses of outcomes and costs in CHF care pathways (CONCEPT-CHF).
Task 3. Carrying out cross-regional federated analyses of outcomes and costs on ischemic stroke care pathways (CONCEPT-Stroke).
Task 4. Carrying out cross-regional federated analyses of outcomes and costs on atrial fibrillation (CONCEPT- AF).
Task 5. Carrying out cross-regional federated analyses of outcomes and costs on severe mental health disorders (CONCEPT-Mental Health).
Task 6. Carrying out cross-regional federated analyses of outcomes and costs on patients in need of emergency care (CONCEPT EC).
Task 7. Carrying out cross-regional analysis of costs and cost-effectiveness for the rest of CONCEPT projects (CONCEPT-Costs).
OBJETIVES
Health promotion and prevention strategies in primary care and the community
Screening, diagnosis and management of the most relevant diseases in primary care
Chronic diseases and multimorbidity
Innovative and responsible research, gender perspective and implementation
Patient-centered interventions, RWD, and methodological improvements
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