Improving the quality of care and prevention for people with chronic diseases in Europe

Improving the quality of care and prevention for people with chronic diseases in Europe

A heavy price for chronic diseases – A wealth of knowledge exists on effective and efficient ways to prevent and manage chronic diseases.

The CHRODIS Recommendations and Criteria (QCR tool) aim to provide high-quality care for people with chronic diseases. It consists of a set of nine Recommendations and Criteria.

Pilot action design: a blueprint for action

A framework for the implementation of actions using CHRODIS Recommendations and Criteria (QCR tool) across European countries.

Guide for the implementation of JA CHRODIS Recommendations and Criteria (QCR) to improve the quality of care for people with chronic diseases 

Lessons learnt based on experiences in pilot actions across eight European countries

Pilot action design: a blueprint for action

A framework for the implementation of actions using CHRODIS Recommendations and Criteria (QCR tool) across European countries.

Guide for the implementation of JA CHRODIS Recommendations and Criteria (QCR) to improve the quality of care for people with chronic diseases

Lessons learnt based on experiences in pilot actions across eight European countries

A practical guide to help those who are going to design, develop, implement, and monitor practices in the field of chronic disease management.

Guide on the implementation of good practices – Leaflet

Based on results of JA CHRODIS PLUS from 8 countries using JA CHRODIS RECOMMENDATIONS AND CRITERIA (QCR)

English | Spanish | Bulgarian | Croatian | Finnish | German | Greek | Serbian | Slovenian

Guide on how to apply CHRODIS PLUS good practices – Layman version  

Based on results of JA CHRODIS PLUS from 8 countries using JA CHRODIS RECOMMENDATIONS AND CRITERIA (QCR)

English | Spanish | Bulgarian | Croatian | Finnish | German | Greek | Serbian | Slovenian

Guide for the implementation of good practices – Short version

Based on results of JA CHRODIS PLUS from 8 countries using JA CHRODIS RECOMMENDATIONS AND CRITERIA (QCR)

English | Spanish | Bulgarian | Croatian | Finnish | German | Greek | Serbian | Slovenian

Seven essential steps for the implementation of CHRODIS Recommendations and Criteria (QCR)

The implementation process of CHRODIS Recommendations and Criteria is based on the experiences in pilot actions in 8 European countries. There are seven essential steps from idea to sustainable implementation:

Establishment of the core leadership group and the implementation working group

Various aspects of governance and leadership have to be addressed prior to practice design. The core leadership group is central in identifying relevant stakeholders to be involved in the various stages of the process, outlining their roles and responsibilities. It is a group that plans, organises, monitors, shares, reports and provides support during the pursuit of practice objectives.

When establishing the implementation working group, core leadership group has to identify stakeholders to be included and at which level – individuals, institutions or organizations that are in any way involved or affected by the activity. The stakeholders may represent institutions, organizations or individuals with distinctive knowledge and experiences in health, education, social, employment, research and Information and Communication Technology (ICT) sectors, NGOs, patient associations and civil society.

Scope of the practice

The implementation working group, led by core leadership group, in this phase outlines the problem that the practice will be addressing, defines its purpose and involvement of target population and selects the CHRODIS Recommendations and Criteria that are core to the successful implementation.

The nature and significance of the local problem is outlined, based on the available knowledge. It summarizes what is currently known about the problem with reference to relevant previous studies.

General purpose has to be clear and established together with all members of implementation working group; it should reflect the needs of the target population.

When defining the target population, relevant dimensions of equity should be adequately taken into consideration and targeted (i.e. gender, socioeconomic status, ethnicity, rural-urban area and vulnerable groups).

Establishment of the core leadership group and the implementation working group

Scope of the practice

Various aspects of governance and leadership have to be addressed prior to practice design. The core leadership group is central in identifying relevant stakeholders to be involved in the various stages of the process, outlining their roles and responsibilities. It is a group that plans, organises, monitors, shares, reports and provides support during the pursuit of practice objectives.

When establishing the implementation working group, core leadership group has to identify stakeholders to be included and at which level – individuals, institutions or organizations that are in any way involved or affected by the activity. The stakeholders may represent institutions, organizations or individuals with distinctive knowledge and experiences in health, education, social, employment, research and Information and Communication Technology (ICT) sectors, NGOs, patient associations and civil society.

The implementation working group, led by core leadership group, in this phase outlines the problem that the practice will be addressing, defines its purpose and involvement of target population and selects the CHRODIS Recommendations and Criteria that are core to the successful implementation.

The nature and significance of the local problem is outlined, based on the available knowledge. It summarizes what is currently known about the problem with reference to relevant previous studies.

General purpose has to be clear and established together with all members of implementation working group; it should reflect the needs of the target population.

When defining the target population, relevant dimensions of equity should be adequately taken into consideration and targeted (i.e. gender, socioeconomic status, ethnicity, rural-urban area and vulnerable groups).

Baseline analysis of situation and context

Before the action plan is designed, relevant contextual factors that might affect the implementation should be identified and analysed using quantitative, qualitative or mixed methodology.

Quantitative methodology: data can be collected from data registries, questionnaires, and forms which produce numeric data. Data analysis includes statistical procedures or score construction.

Qualitative methodology: data is usually collected with open-ended questionnaires, semi-structured interviews, participatory observation and interactive sessions (workshops, SWOT analysis, ‘World cafe’) or by extraction of data from written sources.

Design of pilot action plan

Baseline (situation and context) analysis helps to outline the specific local problem in more detail.  At this point, it is advisable to check again the scope of the intervention and make adjustments, based on the information acquired from the analysis. In pilot action plan, specific objectives, activities, responsibilities, timeline and key performance indicators are defined

The practice objectives and strategy have to be transparent to the target population and stakeholders involved. Per each specific objective, one or more activities are defined making clear who is responsible for a particular activity implementation and who is involved. The action plan has to create ownership among the target population and stakeholders. Implementation of each activity should be realistic in terms of duration.

Monitoring and evaluation of the implementation

Day one of the implementation process has to be defined. It is advisable to use visual methods (e.g. Gantt chart) to describe the timeline.

Intermediary evaluation of the intervention can be performed using CHRODIS Recommendations and Criteria. The intermediary evaluation includes the assessment of key performance indicators. Final evaluation at the conclusion of the intervention may have the same structure.

The outcomes of the evaluation should be at every point linked to action to foster continuous learning and/or improvement and/or to further reshape the practice. They are to be shared among relevant stakeholders, showing the link to the defined goals and objectives. Evaluation has to address social and economic aspects from both target population, and formal and informal caregiver perspectives, if applicable.

Reporting of the results

When intervention is concluded, the implementation working group reflects on the job done, and writes a report on the entire implementation process. Reporting also conveys core information and messages the scientific, professional and lay communities as well as to the decision-makers, and is an essential building element for the sustainability and scalability.

The report of the implementation process should be structured and aligned to the guidelines that are used in scientific and professional publications. Partners in CHRODIS PLUS were using SQUIRE 2.0 Guidelines.

Monitoring and evaluation of the implementation

Reporting of the results

Day one of the implementation process has to be defined. It is advisable to use visual methods (e.g. Gantt chart) to describe the timeline.

Intermediary evaluation of the intervention can be performed using CHRODIS Recommendations and Criteria. The intermediary evaluation includes the assessment of key performance indicators. Final evaluation at the conclusion of the intervention may have the same structure.

The outcomes of the evaluation should be at every point linked to action to foster continuous learning and/or improvement and/or to further reshape the practice. They are to be shared among relevant stakeholders, showing the link to the defined goals and objectives. Evaluation has to address social and economic aspects from both target population, and formal and informal caregiver perspectives, if applicable.

When intervention is concluded, the implementation working group reflects on the job done, and writes a report on the entire implementation process. Reporting also conveys core information and messages the scientific, professional and lay communities as well as to the decision-makers, and is an essential building element for the sustainability and scalability.

The report of the implementation process should be structured and aligned to the guidelines that are used in scientific and professional publications. Partners in CHRODIS PLUS were using SQUIRE 2.0 Guidelines.

Planning for sustainability of the practice and to increase the potential for scale-up

Sustainability and scalability aspects of the practice should be considered at all stages of the implementation. For achieving sustainability, there should be a broad support to the implemented practice amongst those who have implemented it, or by those who intend to. Continuation of the practice can be ensured through institutional anchoring and/or ownership by the relevant stakeholders or communities, facilitated by implementation working group and/or core leadership group.

Establishing and/or fostering connections with decision-makers and the local community is another important mechanism for building the sustainability and the potential for scalability.

How can you use the CHRODIS Recommendations and Criteria where you are?

QCR was tested in a series of pilot actions across eight different countries to improve and evaluate existing practices. This has provided a wealth of information on the barriers and facilitators related to any of the specific QCR’s, as well as the contextual elements of each healthcare system where they were implemented.

Learn how we implemented the CHRODIS Recommendations and Criteria in multiple locations:

Slovenia

Care model development by local working group in Novo Mesto and other surrounding communities, based on a case study of chronic wounds.

Click here to download the report.

Finland

Showcasing chronic disease prevention tips to undeserved and vulnerable groups, in collaboration with the Finnish Somali League and the Helsinki Somali community.

Click here to download the report.

Germany

Development of the tinnitus education app (TinnitusTipps) to supply chronic tinnitus patients with high-quality information and tips for dealing with their condition.

Click here to download the report.

Croatia

Quality of care indicators for non-communicable diseases (NCD).

Click here to download the report.

Serbia

Prevention and care of NCDs using diabetes as a model disease.

Click here to download the report.

Bulgaria

Empowering people with diabetes through the use of mHealth technology.

Click here to download the report.

Greece

Self-management education and training of people with cardiovascular risk factors: hypertension and diabetes.

Click here to download the report.

Spain

Improving chronic disease care (with particular focus on diabetes) in the Cantabria region through the use of mHealth technology.

Click here to download the report.

Project leaders and partners:

Jelka Zaletel | National Institute of Public Health, Slovenia

Marina Maggini | National Institute of Health, Italy

Flavia Pricci | National Institute of Health, Italy

“We were very happy to see how the “CHRODIS family“ was assembled during the last joint action. Now that the network of enthusiastic colleagues is getting stronger and bigger, we are able to produce breakthrough ideas, successfully manage the process in line with the results and still keep our minds open to ideas of others. The CHRODIS PLUS Joint Action has the opportunity to open many doors, that may lead to better health in EU, and we believe that ‘chrodisians’ have the knowledge, experience, energy and wisdom to make it happen. From producing results at the personal/patient level to working with policy makers from Member States, and doing all of that with passion, is how we personally see the CHRODIS PLUS family”.

  • WP Leader: National Institute of Health (ISS), Italy. Marina Maggini, marina.maggini@iss.it
  • WP Co-Leader: National Institute of Public Health (NIJZ), Slovenia. Jelka Zaletel, jelka.zaletel@kclj.si
  • International Centre of Excellence in Chronicity Research (KRONIKGUNE), Spain
  • European Patient Forum (EPF)
  • University of Ulm (UULM), Germany
  • Croatian Institute of Public Health (CIPH), Croatia
  • University Hospital Regensburg (UHREG), Germany
  • Aristotle University of Thessaloniki (AUTH), Greece
  • Centre for Research & Technology Hellas (CERTH), Greece
  • Otto von Guericke University Magdeburg (OVGU), Germany
  • Cantabrian Health Service (CSC), Spain
  • National Institute for Health and Welfare (THL), Finland
  • National Center of Public Health and Analyses (NCPHA), Bulgaria
  • Faculty of Medicine at the University of Belgrade (UBEO), Serbia
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