Abstract
Background: In the European Union (EU), nearly 63 million people live with cardiovascular diseases, threatening the sustainability and resilience of the healthcare systems. Heart failure (HF) is a major public health issue, particularly as its prevalence is rising with an ageing population. In the Basque Country (Spain), HF affects 6.8% of the general population and 16.1% of people over 75. It is the main cause of hospitalisation in people over 65, burdening patients and their families and putting a strain on healthcare resources. The systematic management of patients with HF is therefore a priority to improve the quality of life of patients and their families, but also to reduce hospital admissions and associated morbidity and mortality.
Approach: The Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) is one of the initiatives of the EU4Health Programme to reduce the burden of non-communicable diseases that involves 21 European countries and over 300 experts. JACARDI will implement 142 pilot projects during 4 years (October 2023-2027) that cover the entire patient journey using a harmonized implementation methodology.
In the Basque Country, the project works on the design, implementation and evaluation of an integrated care pathway for HF patients targeting more than 20,000 people in 13 Integrated Healthcare Organisations (IHOs). The co-design of the pathway with healthcare professionals, managers and the community emphasises shared decision-making to ensure care coordination and continuity of care, towards a model where patients are engaged, informed and supported to look after their own health and wellbeing.
Led by the Ministry of Health of the Basque Government, the initiative is supported by various departments in the 13 IHOs of the Basque Healthcare service Osakidetza (clinical, administrative, quality and innovation, humanisation) and is based on the recently launched Value-Based Healthcare Strategy and the Protocol for the Management of HF Patients in the Region.
Results: A multifaceted intervention will tackle key challenges in the implementation of care pathways by:
•Outlining clinical guidelines to establish a corporate and equitable vision also on social prescribing, mental health and wellbeing and self-management of patients with HF.
•Addressing technological requirements by integrating the pathway into a unified electronic health record for enhanced clinical safety and continuity of care.
•Designing an evaluation framework including patient-reported outcomes to measure results in providing better value for patients, communities and health care systems alongside its cost.
•Developing a training program for professionals to understand patient expectations and measure their experience, while training facilitators in implementation science.
•Raising awareness through a structured communication and dissemination plan and fostering discussion among the professionals of the 13 IHOs involved.
Implications: This project represents a significant opportunity to redesign care delivery in the Basque Country region and enhance HF patients’ quality of life, while improving population health and clinicians’ experience and reducing per capita healthcare costs.
This process will draw on evidence relevant to the value-based care approach and implementation science, which is essential to bridge the gap between research and routine clinical practice, while pushing towards gender equality.