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BeyondSilos Evaluation Framework

Background and rationale

The protocol evaluates the impact of the new organisational models developed in the framework of the BeyondSilos pilot service in order to provide ICT supported integrated health and social care to elderly patients. The evaluation is performed covering the needs of the different principal stakeholders, such as end users (care recipients), informal carers, formal care staff/professionals, managers, decision-makers and third-party payers.

Evaluation of integrated health and social care service delivery processes (process evaluation) will improve the current scientifically based knowledge base on barriers and facilitators towards integrated care (IC) delivery. Beyond this, scientific knowledge will be generated on outcomes of IC service delivery from the perspective of all actors involved. Apart from generating a number of self-standing deliverables, this work package directly feeds into WP7 with a view to support further exploitation of project outcomes beyond the end of the project by relevant stakeholders, and wider dissemination during the project.

Main hypothesis

Integrated care will lead to a more personalised and coordinated care, improve outcomes for elderly patients, deliver more effective care and support, and provide more cost efficient health and social services.

Methods

The evaluation is conducted using the MAST multi-dimensional evaluation methodology adapted to the needs of the BeyondSilos project, focusing on ICT supported integrated care.MAST was developed under contract with the European Commission (MethoTelemed project) by a multinational team led by the Odense University Hospital, which was participating in United4Health as part
of the South Denmark Regional Partnership. The same team, which developed and validated MAST, is in charge of the evaluation of BeyondSilos. MAST includes assessment of the outcomes of telemedicine applications divided into the following seven domains:

  1. Health problem and characteristics of the application
  2. Safety
  3. Clinical effectiveness
  4. Patient perspectives
  5. Economic aspects
  6. Organisational aspects
  7. Socio-cultural, ethical and legal aspects.

Study design

The aim of the evaluation is to quantify the relationship between ICT supported integrated care services
to elderly patients and specific outcomes eight months after the deployment of the new organisational
models. The most appropriate study design for the evaluation is the cohort-study (prospective observational study), given that random allocation is not possible.
The strengths of this study design are mainly the collection of real-life data about impact on effectiveness,
costs and organisation (structure,processes, and outcomes) which allows the identification of barriers and facilitators for a wider service implementation. Furthermore, the long follow-up period allows for registering and monitoring long-term health effects and other outcomes, while the large sample size allows for stratification analysis and identification of patient subgroups that benefit most from the intervention.
In addition, from an ethical perspective, if the new care is proved effective,it should be offered to all
potential users in need of integrated health and social care. This type of study design assesses the real
-life effectiveness of the trialled services with a high degree of external validity and generalisability of the
results. Due to inclusion of patients from many European countries, this study will be able to provide a
valid estimate of the expected impact of the new organisational models in other regions of Europe.

Setting

All settings that are in any way relevant to the provision of health and social care are included. Therefore,
out-of-hospital (community) services as well as hospitals, GPs' offices, community nurses, and any type of
care practitioners, users’ homes and volunteer service providers’ offices are engaged. Participants are enrolled and the evaluation is conducted at the following seven pilot sites.

  • Northern Ireland
  • Badalona
  • Valencia
  • Campania
  • Amadora
  • Kinzigtal
  • Sofia

Please find our more about the BeyondSios evaluation framework in D6.1.