Target WP8 - Ricapps

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 Aragon - IACS - IACS

RD21/0016/0023

ebernal.iacs@aragon.es

Participating Groups

AQUAS. IP:

Mireia Espallargues (RD21/0001/0007)

Aragon-IACS. IP:

Enrique Bernal-Delgado (RD21/0001/0023)

Canary Islands. IP:

Lilisbeth Perestelo (RD21/0001/0013)

EpiChron. IP:

Alexandra Prados (RD21/0001/0019)

H. Costa del Sol. IP:

Maximino Redondo (RD21/0001/0015)

IMIM. IP:

María Sala (RD21/0001/0020)

Kronikgune 1. IP:

Susana García (RD21/0001/0017)

Kronikgune 2. IP:

Amaia Bilbao (RD21/0001/0011)

Madrid. IP:

Isabel del Cura (RD21/0001/0027)

Navarra. IP:

Berta Ibáñez (RD21/0001/0016)

Valencia. IP:

Isabel Hurtado (RD21/0001/0006)

Research lines

Line 1 To characterise the services, interventions and policies designed, developed or applied to address the needs of chronically ill and frail patients and improve their health outcomes. Within this line of research, the key themes will be the digital transformation of primary care and adaptive staffing in primary care.

Task 1. To establish a digital roadmap to improve integrated care.

Task 2. To evaluate the unequal distribution of primary care resources in the Spanish National Health System.

Line 2 To identify, analyse and monitor unwarranted variations in the care of chronic and frail patients. Within this line of research, WP8 will examine equity in access to effective care; the appropriate use of clinical interventions; adherence to treatments, in particular among multimorbid patients receiving multiple treatments; the quality and safety of care delivery and its efficiency.

Task 1. Annual update (2022, 2023, 2024) of the Atlas of Potentially Avoidable Hospitalisations in Chronic and Frail Patients at primary care and healthcare area level.

Task 2. Annual update (2022, 2023, 2024) of the Diabetes Care Atlas at primary care level.

Task 3. Delivery of a policy report on treatment patterns and adherence in a series of cohorts: patients with osteoporosis and hip fracture, severe mental illness, and opioid users.

Task 4. To publish an atlas of the quality of urgent care in primary care.

Line 3 To analyse care pathways within and between levels of care. Within this line of research, particular emphasis will be placed on patients with multiple conditions and multiple treatments, and their exposure to primary care, outpatient and inpatient hospital care, emergency care and long-term care.

Task 1. To carry out an interregional analysis of the care pathways for diabetes. Conducting an interregional analysis of care pathways for heart failure.

Task 2. Conducting an interregional analysis of care pathways for long-term breast cancer survivors.

Task 3. Conducting an interregional analysis of the care pathways for patients with ischaemic stroke.

Task 4. Conducting international comparative analyses of care pathways in frail patients.

Line 4 To evaluate the effectiveness and efficiency of continuity of care. Within this line of research, the most effective and efficient care pathways will be identified, those that would optimise continuity of care. Special attention will be paid to patients with multiple conditions and multiple treatments.

Task 1. To carry out an interregional analysis of the outcomes and costs of care pathways for diabetes. To carry out an interregional analysis of the outcomes and costs of care pathways for CHF.

Task 2. To conduct an interregional analysis of the outcomes and costs of care pathways for long-term breast cancer survivors.

Task 3. To carry out an interregional analysis of outcomes and costs in the care pathways for ischaemic stroke.

Task 4. To conduct an interregional analysis of treatment adherence in a series of patient cohorts (osteoporosis, severe mental illness, opioid users).