CHAINE creates common framework for cost-effective, integrated health care delivery across Europe

Leiden 21 March 2000From January 1998 to December 1999, a European Commission funded concerted action was undertaken by a consortium consisting of six member-organisations out of five European countries. The project was called CHAINE since it focused on the creation of a European network to address methodological issues regarding the outbuilding of linked episodes of care in every imaginable health care setting. One of the major aims consisted in the identification and classification of patient treatment, in order to optimise the management of the available resources. This approach was assessed in a big number of concrete case studies within a thematic processing of conceptual, managerial, educational and information technical viewpoints.

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Three specific patient conditions were defined to be evaluated in detail against the pre-set standards of the concertation process, involving patients treated in the primary as well as the acute or intensive care, people with chronic disease, and patients suffering from long term disabilities with a special focus on mental health. The CHAINE consortium organised four regional meetings in West, East, North and Southern Europe to involve some fifty regional and national projects for a total amount of at least 1.000.000 euro. The CHAINE project was primarily intended to provide mutual support to researchers, clinicians, health administrations and policy makers, who are dealing with comparable problems in tools design, allowing to guarantee seamless care across the acute and non acute health care sectors.

The CHAINE team aimed at developing a common framework for an efficient, integrated health care delivery by identifying how care is packaged when a patient is passing through a period of illness or disability. New instruments like Information Technology, were used to describe and analyse the contents, costs, and quality of health care from a patient's perspective, covering whole episodes of care. The consortium adopted an iterative process to determine the user needs for managing the care delivery, to be able to disseminate and discuss the acceptability and validity of the episode concept. The packages of care had to map in detail the interaction of the patient with professional individuals and organisations, active in primary and secondary care, and the community in a way as to meet the different needs of clinicians, managers, commissioners, and most of all the patients.

To address these diverse, complex, but altogether related issues, the CHAINE team defined four specific perspectives for a deeper analysis. The episode of care concept encompassed the "Classification Language" in order to document episode components and select the right method to link them. Second came the management issues, such as costing, planning, evaluation, contracting, quality control, budgeting, and funding. A third factor involved the education and training of end users in the concept of "health care products", the use of information to manage, the documentation of the care process, and how to handle the "power shift", introduced by objective information on care delivery.

The fourth aspect was a technical one, which dealt with the IT aspects of the patient focused patient record, including the unique patient identifier, the security and confidentiality issue, the data warehouse concept, the use of "groupers" and the data production for management purposes. For each of these four issues, a perspective study group consisting of experts from the European field, was co-ordinated by a chair and a co-chair to draw up an inventory of the various aspects for every item, in connection with the three specific patient conditions. As the project focused on a patient oriented management of care, the recent tendency in European health care has been supported in trying to maximise the proven efficiency of a transmural health care delivery within the European community. More information is available on the CHAINE home page.


Leslie Versweyveld

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