Josep Roca

Hospital Clínic de Barcelona · Servicio de Neumología

BACKGROUND Multimorbidity management, a growing healthcare concern, necessitates precise health risk assessment (HRA) tools to increase the efficacy of its interventions and mitigate the disease burden. However, existing solutions often fall short of accurately predicting disease progression and the emergence of new comorbid conditions, hindering t...

In the EU project TRAJECTOME, we used a novel methodology to identify temporal disease maps of depression and highly prevalent co-occurring disease conditions. This information was combined with disability weights established by the Global Burden of Disease Study 2019 to create a depression-related health risk assessment tool, the Multimorbidity Ad...

Key lessons learnt in the Synergy-COPD project, that aimed at a systems medicine approach to patients with chronic obstructive pulmonary disease (COPD), contributed to formulate the concept of multisource predictive modelling for enhanced clinical risk assessment described in the chapter. Further research and innovation developments in the field, a...

Introduction Complex chronic patients (CCP) are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a co-creation process performed into the EU initiative JADECARE (2020-2023) to elaborate an integrated care program aiming at...

Introduction Health risk assessment (HRA) strategies are cornerstone for health systems transformation toward value-based patient-centred care. However, steps for HRA adoption are undefined. This report analyses the process of transference of the Adjusted Morbidity Groups (AMG) algorithm from the Catalan Good Practice to the Marche region (IT) and...

The heterogeneity and complexity of symptom presentation, comorbidities and genetic factors pose challenges to the identification of biological mechanisms underlying complex diseases. Current approaches used to identify biological subtypes of major depressive disorder (MDD) mainly focus on clinical characteristics that cannot be linked to specific...

Background Hospital at home (HaH) was increasingly implemented in Catalonia (7.7 M citizens, Spain) achieving regional adoption within the 2011–2015 Health Plan. This study aimed to assess population-wide HaH outcomes over five years (2015–2019) in a consolidated regional program and provide context-independent recommendations for continuous qualit...

Digital health tools may facilitate care continuum. However, enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. The study presents Health Circuit, a digital health tool with an adaptive case management approach and analyses its healthcare impact, as well as...

BACKGROUND Digital health tools may facilitate care continuum. However, enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. OBJECTIVE The study presents Health Circuit, an adaptive case management approach to support innovative healthcare services, and analy...

Background: Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. Objective: The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patie...

Background: Hospital at home (HaH), either admission avoidance (AA) or early supported discharge (ESD), was increasingly implemented in Catalonia (7.7 M, Spain) for selected patients, achieving regional adoption within the 2011-2015 Health Plan. This study aimed to assess population-wide HaH outcomes over five years (2015-2019) in a consolidated re...

Background Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain)....

Background: Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. Objective: To assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). Meth...

Introduction: The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016-2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilit...

Background Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Cataloni...

Importance: Prehabilitation has potential for improving surgical outcomes as shown in previous randomized controlled trials. However, a marked efficacy-effectiveness gap is limiting its scalability. Comprehensive analyses of deployment of the intervention in real-life scenarios are required. Objective: To assess health outcomes and cost of preha...

BACKGROUND Innovative digital health tools are increasingly being evaluated and, in some instances, integrated at scale into health systems. However, applicability of assessment methodologies in real-life scenarios to demonstrate value generation and, consequently, foster sustainable adoption of digitally enabled health services still shows bottlen...

Background Innovative digital health tools are increasingly being evaluated and, in some instances, integrated at scale into health systems. However, the applicability of assessment methodologies in real-life scenarios to demonstrate value generation and consequently foster sustainable adoption of digitally enabled health interventions has some bot...

BACKGROUND Enhanced management of multimorbidity constitutes a major clinical challenge. Multimorbidity shows well-established causal relationships with high use of healthcare resources and, specifically, with unplanned hospital admissions. Enhanced patients’ stratification is key for achieving effectiveness through personalised post-discharge serv...

Background: Enhanced management of multimorbidity constitutes a major clinical challenge. Multimorbidity shows well-established causal relationships with the high use of health care resources and, specifically, with unplanned hospital admissions. Enhanced patient stratification is vital for achieving effectiveness through personalized postdischarg...

Objective The main objective was to assess repeatability and learning effect of the 6-min walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective, we aimed to identify determinants of improvement in the second test. Materials and methods Secondary analysis from a large prospectiv...

Objective the main objective was to assess repeatability and learning effect of the six-minute walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective we aimed to identify determinants of improvement in the second test. Materials and Methods secondary analysis from a large prospe...

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for...

Background As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challe...

Background: Home hospitalization is widely accepted as a cost-effective alternative to conventional hospitalization for selected patients. A recent analysis of the home hospitalization and early discharge (HH/ED) program at Hospital Clínic de Barcelona over a 10-year period demonstrated high levels of acceptance by patients and professionals, as w...

Background : Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belongs to a subgroup of coronaviruses rampant in bats for centuries. It caused the coronavirus disease 2019 (COVID-19) pandemic. Most patients recover, but a minority of severe cases experience acute respiratory distress or an inflammatory storm devastating many organs that...

Introduction The impact of pulmonary hypertension (PH) on exercise tolerance in chronic obstructive pulmonary disease (COPD) has not been fully elucidated. It is necessary to characterize pulmonary hemodynamics in patients with moderate to severe COPD in order to improve their management. The aim of the study was to determine whether in COPD the pr...

Libro de Texto de Medicina Interna en dos volumenes

BACKGROUND Home hospitalization is widely accepted as a cost-effective alternative to conventional hospitalization for selected patients. A recent analysis of the home hospitalization and early discharge (HH/ED) program at Hospital Clínic de Barcelona over a 10-year period demonstrated high levels of acceptance by patients and professionals, as wel...

Abstract—Forced spirometry testing is gradually becoming available across different healthcare tiers including primary care. It has been demonstrated in earlier work that commercially available spirometers are not fully able to assure the quality of individual spirometry manoeuvres. Thus a need to expand the availability of high quality spirometry...

Background: Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients’ functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality ar...

Background: Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients' functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality a...

Background: Multimorbidity is highly relevant for both service commissioning and clinical decision-making. Optimization of variables assessing multimorbidity in order to enhance chronic care management is an unmet need. To this end, we have explored the contribution of multimorbidity to predict use of healthcare resources at community level by com...

The current study analyzes the information collected and the lessons learned during the first six months of the CONNECARE project in Israel, in order to assess the use of the mobile technology by patients, their motivations and obstacles; as well as their satisfaction. As of the middle of February 2019, 59 patients were recruited and 18 discharged...

Patients with chronic obstructive pulmonary disease (COPD) generate a high, and growing, burden on Health Systems worldwide due to COPD prevalence, population aging and co-morbidites. The chapter analyses COPD as a representative use case of non-communicable disorders and analyses the main challenges faced by clinicians and health scientists in ord...

Introduction: The impact of pulmonary hypertension (PH) on exercise tolerance in chronic obstructive pulmonary disease (COPD) has not been fully elucidated. It is necessary to characterize pulmonary hemodynamics in patients with moderate to severe COPD in order to improve their management. The aim of the study was to determine whether in COPD the...

BACKGROUND Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by mHealth can enhance patients’ self-efficacy. It is widely accepted that mHealth-supported services might enhance productive interactions among the...

Background: Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive...

Background: Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the imple...

Introduction: The efficacy of prehabilitation (PreHab) to reduce surgical complications, and facilitate postoperative recovery, has been demonstrated (Ann Surg. 2018; 267(1):50-56). Deployment of PreHab as mainstream service at Hospital Clínic de Barcelona (HCB) has been undertaken. However, there is a need for consolidation of modular digital heal...

As the average age of the population increases, so will the prevalence of chronic respiratory diseases and associated multimorbidity. This will result in a more complex clinical environment. Part of the solution will be to allow patients to be co-creators in the design of their care. It will also require clinicians to shift in their current approac...

Home hospitalization (HH) is presented as a healthcare alternative capable of providing high standards of care when patients no longer need hospital facilities. Although HH seems to lower healthcare costs by shortening hospital stays and improving patient's quality of life, the lack of continuous observation at home may lead to complications in som...

Background Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-sc...

BACKGROUND Digital health tools comprise a wide arrange of technologies to support health processes. The potential of these technologies to effectively support healthcare transformation is widely accepted. However, wide scale implantation is uneven among countries/regions. Identification of common factors facilitation and hampering the implementati...

Background: Prehabilitation showed efficacy to reduce postoperative complications. However, sustainability of its health benefits and impact on costs needs further assessment. Objective: To assess the mid-term clinical impact and costs from a hospital perspective of an endurance exercise training-based prehabilitation program in high-risk patients...

Aim We hypothesize that training‐induced changes in muscle oxygen saturation (StO2) assessed by near‐infrared spectroscopy (NIRS) during constant work‐rate cycling exercise (CWRE) may be a useful marker of the effects of training at “vastus medialis” of the quadriceps in patients with chronic obstructive pulmonary disease (COPD). Methods Increment...

La medición de la función pulmonar es una parte fundamental del diagnóstico de los pacientes con sospecha de enfermedades respiratorias, pues permite definir la gravedad de la enfermedad y facilita el seguimiento evolutivo de los pacientes. Asimismo, desempeña un importante papel en la evaluación de la capacidad para tolerar intervenciones que pued...

Due to profound changes occurring in biomedical knowledge and in health systems worldwide, an entirely new health and social care scenario is emerging. Moreover, the enormous technological potential developed over the last years is increasingly influencing life sciences and driving changes toward personalized medicine and value-based healthcare. Ho...

Background: Technology-supported integrated care services can enhance clinical management of chronic patients. But, the role of an electronic Personal Health Folder (ePHF) and mobile technology (mHealth) to facilitate behavioral change is not clear. Objective: To assess the impact of an intervention supported by mHealth on behavioral aspects and he...

Introduction Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease characterised by persistent respiratory symptoms. A focus of COPD interventional studies is directed towards prevention of exacerbations leading to hospital readmissions. Telehealth as a method of remote patient monitoring and care delivery may be implem...

Background: Chronic diseases are generating a major health and societal burden worldwide. Healthy lifestyles, including physical activity (PA), have proven efficacy in the prevention and treatment of many chronic conditions. But, so far, national PA surveillance systems, as well as strategies for promotion of PA, have shown low impact. We hypothes...

Introduction Comorbidities in patients with chronic obstructive pulmonary disease (COPD) generate a major burden on healthcare. Identification of costeffective strategies aiming at preventing and enhancing management of comorbid conditions in patients with COPD requires deeper knowledge on epidemiological patterns and on shared biological pathways...

Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored. Objective To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. Methods Pro...

Background: Clinical management of patients with chronic obstructive pulmonary disease (COPD) shows potential for improvement provided that patients' heterogeneities are better understood. The study addresses the impact of comorbidities and its role in health risk assessment. Objective: To explore the potential of health registry information to...

Background Chronic obstructive pulmonary disease (COPD) patients often show skeletal muscle dysfunction that has a prominent negative impact on prognosis. The study aims to further explore underlying mechanisms of skeletal muscle dysfunction as a characteristic systemic effect of COPD, potentially modifiable with preventive interventions (i.e. musc...

Objective: The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery. Summary background data: Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surg...

Breath analysis holds the promise of a non-invasive technique for the diagnosis of diverse respiratory conditions including COPD and lung cancer. Breath contains small metabolites that may be putative biomarkers of these conditions. However, the discovery of reliable biomarkers is a considerable challenge in the presence of both clinical and instru...

Foreword The PITES Telemedicine and e-Health innovation platform constitutes a network intervention framework for research and innovation in solutions, services and tools based on Information and Communications Technologies (ICTs) aimed at supporting the new assistance models. Formally, PITES is a grouping of nodes of technological innovation based...