Research team

Primary and interdisciplinary care Antwerp (ELIZA)

Expertise

Health systems research Implementation research, including intervention studies in the domain of health services and health systems multicountry studies Mixed methods design Research in low and middle income countries

Determinants of diabetes care and outcomes: a multi-level analysis across the continuum of care. 01/01/2021 - 31/12/2024

Abstract

Type 2 Diabetes (T2D) is one of the leading causes of death in the world (3.7 million deaths/year). In Belgium, 6.1% of the population is diagnosed with diabetes. Effective treatment exits and is relatively straightforward from a technical point of view, but T2D care is socially and organizationally complex. It requires lifelong follow-up and self-management along a continuum of care: patients need to be diagnosed, treated, followed-up, and supported to achieve glycaemic control. Unfortunately, people (especially vulnerable groups) are lost at each of these steps, leading to complications and avoidable hospitalizations. Knowledge is urgently needed on the determinants of these leakages in the care continuum. In accordance with the socioecological model, we aim to disentangle the determinants of drop-out at 3 levels (patient, health system & community level) through an innovative multilevel Cascade-of-Care approach. The Cascade-of-Care visualizes the drops between the steps of the care continuum while our multilevel analyses will attempt to explain each drop using determinants at the 3 levels. We will build a unique dataset combining (1) individual health insurance and medical lab data, (2) organizational data of primary care practices and (3) administrative and self-gathered data of neighborhoods. Spatial multilevel analysis will allow us to assess (1) the relative impact of and (2) interaction between the determinants at these 3 levels on each step of the continuum of care.

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Integrated Care: changing landscape, new needs 01/10/2019 - 30/09/2024

Abstract

Introduction. Globalization, innovation, urbanization, climate change and ageing have consequences for public health and for health care systems. It has led to new health problems, to more diversity among the population, to a different societal context, and to new possibilities and threats in the health care system. Answers to these global and local challenges include intersectoral collaboration and integration. Belgium is undertaking steps to move to more integrated care, with initiatives like first line zones and decentralization of health care towards primary care level. Few initiatives are evaluated, which leaves a knowledge gap on implementation, effectiveness and cost. This proposal aims to contribute to implementation and evidence of high quality integrated care, in Belgium and in other contexts Research objectives. The objectives of the research plan are to increase quality of integrated care, by 1) respond better to diversity and new health needs in the changing society; 2) adaptation, implementation and evaluation of health and care models that strengthen links between public health and primary care and between patient, health providers and community; and 3) to contribute to sustainable change by improving institutional and health system context for integrated care, through linkage between health policy and implementation. Approach and methods. The plan builds upon the transversal themes of 1) diversity and vulnerable groups and changing health needs, in particular multi-morbidity; 2) new forms of organization and collaboration and; 3) role of data and information systems. The underlying conceptual approach takes into account health systems dynamics, meaning the study of the relations between different elements in the system and with the context. It is structured in three work packages. WP1 examines the variation and cost of multi-morbidity; implementation and effectiveness of interventions to address diversity and multi-morbidity; and the monitoring of multi-morbidity in health systems. WP2 studies network dynamics and outcomes of provider collaboration and patient health care utilization in different care models; task-shifting and intersectoral collaboration. WP3 examines digital tools support vulnerable groups; strengthening of data management systems to support collaboration and integrated care and evaluates the impact of increased sharing of health information data on patients and society. The methods will include epidemiological surveys, secondary data analyses of quantitative datasets, health expenditure and costing analyses, and stakeholder analyses using qualitative methods. The identified priority areas in this proposal provide opportunities to link existing research work of the four spearhead research groups, and collaboration with operational partners and policy makers in the local and regional context of Antwerp. Impact. After 5 years, this research strategy has led to the following results. 1) new knowledge on multi-morbidity among different population groups; 2) evidence on effects and cost of new care models in the Belgium context,; and 3) utilization of digital tools and health data for research and practice; and 4) recognition of the spearhead research of the UA on quality of integrated care.

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Multimorbidity and its cost in the Belgium health system. 01/10/2019 - 31/12/2023

Abstract

MultiMorbidity (MM), the concurrence of two or more chronic conditions, is a growing phenomenon in all countries, and more prevalent among vulnerable groups in society. Yet, research to understand and address the phenomenon has only recently taken off. In the Belgium context, the burden of multimorbidity, measured by disability, is highest for cardiovascular diseases with or without diabetes; chronic respiratory diseases and depression; neurological diseases and cancers. The prevalence of MM has risen from 8,9% in 1997 to 15,2% in 2018. How patients use health care for their different conditions is not well known, while this has implications for quality of care and cost. Best practices in health care organizations to manage multimorbidity are being documented, but implementation research on feasibility, cost and effectiveness is still patchy. The PhD aims to improve understanding the burden, management and cost of multimorbidity in the Belgium health system, from the patient and health system perspective. Two Research Questions will be examined: 1) What are patterns of health care utilisation and health care cost for people with multiple chronic conditions? 2) Which innovations to manage multimorbidity are implemented, and what is the feasibility acceptability and effectiveness and cost of implementation? Year 1 and 2 will be used to develop the research protocol, explore existing data and to do the analysis of RQ1. Year 2 and 3 will be used for RQ. At least drie peer reviewed articles will be written with the following topics: 1) health care utilization and cost for Belgium patients with multiple chronic conditions; 2) implementation analysis of pilots for integrated care for multimorbidity; and 3) cost-effectiveness of multimorbidity pilots in the Belgium health system.

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Scale Up an integrated care package for diabetes and hypertension for vulnerable people in Cambodia, Slovenia and Belgium (SCUBY). 01/01/2019 - 30/06/2023

Abstract

Background: Diabetes and hypertension are increasingly dominant in the global burden of disease. Effective interventions for prevention, detection, treatment and control of both conditions are available, but do not reach all people in need. Countries are struggling how to scale-up interventions sustainably and effectively. There is an urgent need to develop and document strategies on how to do so. Method: This project examines the scale-up of existing evidence-based packages for control of diabetes and/or hypertension with five components: (a) identification of people with hypertension and/or type 2 diabetes and (b) treatment in primary care services, (c) health education and (d) self-management support to patients and caregivers, and (e) collaboration among caregivers. The project develops, implements and evaluates roadmaps for the national scale-up of this package, in three different types of countries: a low-middle income country with a developing health system (Cambodia), a former socialist country with a centralised health system (Slovenia), and a Western European country with a decentralised system (Belgium). The research objectives are: 1) to analyse the organisational capacity to scale-up the integrated care package and to assess contextual barriers and facilitators; 2) to develop and implement roadmaps for a national scale-up strategy in each country; 3) to evaluate the impact of scale-up on health outcomes and costs; and 4) to generate lessons for other countries. Outcomes: The project will result in comprehensive scale-up strategies and increased diabetes and hypertension control in each country. The involvement of policy-makers, professionals and patients will ensure the local relevance and impact. The project is innovative in applying the conceptual insights from scale-up science to the field of noncommunicable diseases. The lessons on scale-up will benefit policy-makers in other countries with similar contexts.

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Capacity building for optimizing primary care and community initiatives for Type II Diabetes in Cambodja. 01/01/2019 - 31/12/2022

Abstract

Cambodia is confronted with a growing diabetes epidemic, translated in an increase of the prevalence of deaths attributable to this chronic disease by 42.9% between 2005 and 2016. The diabetes epidemic is projected to severely hamper the country's much needed developmental progress. The country's public health system has been primarily designed to tackle acute diseases and is therefore not capable of comprehensively addressing this public health problem. The proposed project intends to address this problem by joining forces with two local actors – NIPH and MoPoTsyo – to generate context-sensitive strategies to co-create comprehensive but context-specific diabetes care. More specifically, it aims to (1) investigate where current policies and strategies differ from the optimal WHO ICCC framework, and (2) see how these differences translate in suboptimal outcomes in diabetes management, and finally (3) develop roadmaps (together with the stakeholders) to overcome the shortcomings in the current approaches.

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Identification of predictive models of COVID-19 severity in a multi-state setting for its use in risk stratification and care management (ID-CoV). 20/10/2020 - 28/02/2021

Abstract

During the course of the COVID-19 outbreak, a wealth of data has been accumulated from the efforts of the health systems to overcome the pandemic. Months of patient encounters with primary to tertiary care systems are leaving an affluence of valuable information reflecting the real impact of the virus in people's health and lives. These real-world data [RWD] offer an unparalleled opportunity to understand COVID-19 but also an important analytical challenge due to the dissimilar and heterogeneous nature of this information. Using complementary data sources from primary health care and hospitals, this project aims to set up a methodological framework for data harmonization, linkage, and analytical development of a novel tool for multi-state risk prediction identifying the role of comorbidities, among other factors, in predicting COVID-19 progression into severity, and subsequent recovery or death. This research will afford a unique instrument for risk stratification and resource allocation in the face of current and future epidemics and will serve as a proof of concept of the usefulness of RWD and the feasibility of the adaptation of novel this methodological framework to other countries/settings based on local data.

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