Browsing by Author "Zamorano Pichard, Paula Francisca"

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    Economic evaluation of a multimorbidity patient centered care model implemented in the Chilean public health system
    (2023) Zamorano Pichard, Paula Francisca; Espinoza Sepúlveda, Manuel Antonio; Varela, Teresita; Abbott, Tomás; Tellez, Alvaro; Armijo Escalona, Nicolás Andrés; Suarez, Francisco
    Multimorbidity and patient-centered care approaches are growing challenges for health systems and patients. The cost of multimorbidity patients and the transition to a new care strategy is still sightly explored. In Chile, more than 70% of the adult population suffer from multimorbidity, opening an opportunity to implement a Multimorbidity patient-centered care model. The objective of this study was to perform an economic evaluation of the model from the public health system perspective. The methodology used a cost-consequence evaluation comparing seven exposed with seven unexposed primary care centers, and their reference hospitals. It followed three steps. First, we performed a Time-Driven Activity-Based Costing with routinely collected data routinely collected. Second, we run a comparative analysis through a propensity score matching and an estimation of the attributable costs to health services utilization at primary, secondary and tertiary care and health outcomes. Third, we estimated implementation and transaction costs. Results showed savings in aggregate costs of the total population (-0.12 (0.03) p?
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    Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile
    (2023) Varela, Teresita; Zamorano Pichard, Paula Francisca; Muñoz, Paulina; Rain, Carolina; Irazoqui, Esteban; Sapag Muñoz de la Peña, Jaime; Tellez, Alvaro
    Abstract Background Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. Objective This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. Methods a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model’s sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. Results The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. Conclusion It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.
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    Integrating Noncancer Chronic Pain to Multimorbidity: A Real Practice Challenge in Chile
    (Elsevier Inc., 2023) Varela Yuraszeck, Teresita Ines; Zamorano Pichard, Paula Francisca; Rodríguez Lobo, María Victoria; Espinoza Sepúlveda, Manuel Antonio
    © 2023 International Society for Health Economics and Outcomes ResearchChronic noncancer pain (CNCP) is, and continues to be, a global problem that affects people with multimorbidity. The objective is to comment on the gap in Chile in integrating multimorbidity and CNCP in the real practice context despite the advances in public policies and local evidence revealed. Therefore, a pilot is responding to this problem by implementing an approach to incorporate into a multimorbidity comprehensive approach the assessment of CNCP and adding nonmedical services. It is expected to evaluate its impact on the performance of the health system, as well as on people.