Integrated care services: lessons learned from the deployment of the NEXES project

Objectives:  To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. Setting:  One health care sector in Spain (Barcelona) ( n  = 11.382); six municipalities in Norway (Trondheim) ( n  = 450); and one hospital in Greece (Athens) ( n  = 388). Method:  The four services were: (i) Home-based long-term maintenance of rehabilitation effects ( n  = 337); (ii) Enhanced Care for frail patients,  n  = 1340); (iii) Home Hospitalization and Early Discharge ( n  = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) ( n  = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. Results:  The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease ( p p p p Conclusions:  The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.