Joana Mora

ALPHA-fitness test battery: health-related field-based fitness tests assessment in children and adolescents

Hereby we summarize the work developed by the ALPHA (Assessing Levels of Physical Activity) Study and describe the tests included in the ALPHA health-related fitness test battery for children and adolescents. The evidence-based ALPHA-Fitness test battery include the following tests: 1) the 20 m shuttle run test to assess cardiorespiratory fitness; 2) the handgrip strength and 3) standing broad jump to assess musculoskeletal fitness, and 4) body mass index, 5) waist circumference; and 6) skinfold thickness (triceps and subscapular) to assess body composition. Furthermore, we include two versions: 1) the high priority ALPHA health-related fitness test battery, which comprises all the evidence-based fitness tests except the measurement of the skinfold thickness; and 2) the extended ALPHA health-related fitness tests battery for children and adolescents, which includes all the evidence-based fitness tests plus the 4 x 10 m shuttle run test to assess motor fitness.

Criterion related validity of 1/2 mile run-walk test for estimating VO2peak in children aged 6-17 years.

We assessed the criterion related validity of 1/2 mile run/walk (1/2MRW) test for estimating VO2peak in children aged 6-17 years. The criterion related validity of the Fernhalls equation in a sub-group of children aged 10-17 years was also examined. A total of 86 children completed a maximal graded treadmill test and the 1/2MRW test. The cohort was randomly divided into either validation (n=47) or a cross-validation (n=39) group. A regression equation was computed and assessed through several error measures, and the Bland and Altman method. There was no systematic bias in the validation group nor in the cross-validation group (P > 0.1). The root mean sum of squared errors (RMSE), and the percentage error were 6.5 ml/kg/min, and 13.9%, respectively. These figures were very similar in the cross-validation group. The new equation had a lower RMSE and percentage error than the Fernhalls Equation (6.2 vs. 19.7 ml/kg/min, and 16% vs. 50.4%, respectively, P<0.001). The Fernhalls equation showed a significant underestimation of VO2peak (18.1 ml/kg/min, P<0.001). In conclusion, the new regression equation is valid for estimating VO2peak from the 1/2MRW time, sex, and body mass index in healthy children aged 6-17 years, and is more accurate than Fernhalls equation in the sample studied.

Proposals for enhanced health risk assessment and stratification in an integrated care scenario.

Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. Settings The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Participants Responsible teams for regional data management in the five ACT regions. Primary and secondary outcome measures We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. Results There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. Conclusions The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require prospective evaluation.

Selection of the method to appraise and compare health systems using risk stratification: the ASSEHS approach

To face the challenge of active and healthy ageing, European Health Systems and services should move towards proactive, anticipatory and integrated care. The comparison of methods to combine results across studies and to determine an overall effect was undertaken by the EU project ASSEHS (Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services, EU project (No. 2013 12 04). The questions raised in ASSEHS are broad and involve a complex body of literature. Thus, systematic reviews are not appropriate. The most appropriate method appears to be scoping studies. In this paper, an updated method of scoping studies has been used to determine the questions needed to appraise the health systems and services for frailty in the ageing population. Three objectives were set (i) to detect a relevant number of risk stratification tools for frailty and identify the best-in-class, (ii) to understand the feasibility of introducing stratification tools and identify the difficulties of the process and (iii) to find evidence on the impact of risk stratification in Health Services. This novel approach may provide greater clarity about scoping study methodology and help enhance the methodological rigor with which authors undertake and report scoping studies.

Key aspects related to implementation of risk stratification in health care systems-the ASSEHS study

BackgroundThe lack of proven efficacy of new healthcare interventions represents a problem for health systems globally. It is partly related to suboptimal implementation processes, leading to poor adoption of new interventions. Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services (ASSEHS) EU project (N° 2013 12 04) aims to study current existing health Risk Stratification (RS) strategies and tools on frail elderly patients. This paper aims at identifying variables that make the implementation of population RS tools feasible in different healthcare services.MethodsTwo different methods have been used to identify the key elements in stratification implementation; i) a Scoping Review, in order to search and gather scientific evidence and ii) Semi-structured interviews with six key experts that had been actively involved in the design and/or implementation of RS strategies. It aims to focus the implementation construct on real-life contextual understandings, multi-level perspectives, and cultural influences.ResultsA Feasibility Framework has been drawn. Two dimensions impact the feasibility of RS: (i) Planning, deployment and change management and (ii) Care intervention. The former comprises communication, training and mutual learning, multidisciplinarity of the team, clinicians’ engagement, operational plan and ICT display and functionalities. The latter includes case finding and selection of the target population, pathway definition and quality improvement process.ConclusionsThe Feasibility Framework provides a list of key elements that should be considered for an effective implementation of population risk stratification interventions. It helps to identify, plan and consider relevant elements to ensure a proper RS implementation.

New funding and commissioning model as a driving force for the transformation of the Basque Health Service provision model

Introduction and Aim: the new model on financing and contracting (NMFC) of the Basque Health Service (BHS) aims to align and lead the health providing organizations towards the creation of local integrated health systems (LIHS). As such, a LIHS should show: coordination with shared responsibility, strategic objectives according to population risk stratification, improvements in care and health outcomes, and generation of efficiencies. Such proposal aims to provide sustainability to the health system and act as a spurring element for the BHS, given that parts of the generated efficiencies revert into the organization. Material and Methods: Grouping of the health organizations in LIHS according to their population. Definition of the NMFC: linking the 3% of the financing of the BHS to every LIHS (primary care, acute and subacute care hospital), to population interventional plans (PIPs, 0.5%), quality (0.5%) and innovation (0.5%). Definition of PIPs prioritizing most prevalent pathologies and those in need of greater coordination between assistance levels. Use of the stratification tool for the selection of the groups to be intervened proactively. Results: 44 PIPs were displayed, 4 per LIHS (target population): pluripathology (3575), COPD (5294), HF (3699) and Diabetes (10984). An evaluation frame and assessment guidelines were deployed for each intervention and committed resources were distributed for the Intervention Plan. International Journal of Integrated Care – Volume 13, 11 October – URN:NBN:NL:UI:10-1-114680– http://www.ijic.org/ 13 th international Conference on Integrated Care, Berlin, Germany, April 11-12, 2013 2 International Journal of Integrated Care – Volume 13, 23 October – URN:NBN:NL:UI:10-1-114680– http://www.ijic.org/ Discussion: The NMFC implies a series of changes: from specific individual objectives to shared objectives in the same LIHS, from a reactive to a proactive medicine, from activity related payment to measure the results in health, from a generalized attention to an adapted attention depending on the necessity and morbidity of the patients. The change in the model introduces and important change in the work mode and management, i.e, a switch from structure based work to system based work.