A Co-Creation Process Toward Sustainable Adoption of Integrated Care for Prevention of Unplanned Hospitalizations

IntroductionComplex chronic patients (CCP) are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a co-creation process performed into the EU initiative JADECARE (2020-2023) to elaborate an integrated care program aiming at preventing unplanned hospitalizations. MethodsA two-phase process of structured interviews and design thinking (DT) sessions was conducted. Firstly, we assessed the management of CCP in Catalonia (ES) through twenty interviews (five patients and fifteen professionals), including the results of a cluster analysis of 761 hospitalizations, followed by two DT sessions (Oct 2021 to Feb 2022). Then, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two DT sessions with seven professionals. DiscussionThe co-creation process identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during 2023-2025, was generated. ConclusionsA digitally enabled adaptive case management approach to foster collaborative work, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations.