Indoor air quality (IAQ) significantly impacts human health, particularly in enclosed spaces where people spend most of their time. This study evaluates the performance of low-cost IAQ sensors, focusing on their ability to measure carbon dioxide (CO₂) and particulate matter (PM) under real-world conditions. Measurements provided by these sensors were verified against calibrated reference equipment. The study utilized two commercial devices from inBiot and Kaiterra, comparing their outputs to a reference sensor across a range of CO₂ concentrations (500–1200 ppm) and environmental conditions (21–25 °C, 27–92% RH). Data were analyzed for relative error, temporal stability, and reproducibility. Results indicate strong correlation between low-cost sensors (LCSs) and the reference sensor at lower CO₂ concentrations, with minor deviations at higher levels. Environmental conditions had minimal impact on sensor performance, highlighting robustness to temperature and humidity within the tested ranges. For PM measurements, low-cost sensors effectively tracked trends, but inaccuracies increased with particle concentration. Overall, these findings support the feasibility of using low-cost sensors for non-critical IAQ monitoring, offering an affordable alternative for tracking CO₂ and PM trends. Additionally, LCSs can assess long-term exposure to contaminants, providing insights into potential health risks and useful information for non-expert users.

Introduction: Reducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic obstructive respiratory disorders and comorbidities are explainable by multifactorial but actionable factors. The current protocol (January 2024–December 2025) relies on the hypothesis that intertwined actions in four dimensions: (1) management change, (2) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, (3) mature digital support and (4) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies. Accordingly, the main objective is to implement a novel integrated care preventive service for enhanced management of these patients, as well as to evaluate its potential for value generation. Methods and analysis: At the end of 2024, the specifics of the novel service will be defined through the articulation of its four main components: (1) enhanced lung function testing through oscillometry, (2) continuous monitoring of indoor air quality as a potential triggering factor, (3) digital support with an adaptive case management (ACM) approach and (4) predictive modelling for early identification and management of exacerbations. During 2025, the novel service will be assessed using a Quintuple Aim approach. Moreover, the Consolidated Framework for Implementation Research will be applied to assess the implementation. The service components will be articulated through four sequential 6-month plan-do-study-act cycles. Each cycle involves a targeted cocreation process following a mixed-methods approach with the active participation of patients, health professionals, managers and digital experts. Ethics and dissemination: The Ethics Committee for Human Research at Hospital Clinic de Barcelona approved the protocol on 29 June 2023 (HCB/2023/0126). Before any procedure, all patients in the study must sign an informed consent form. Trial registration number: NCT06421402 .

Introduction: Complex chronic patients 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 qualitative analysis performed into the EU initiative JADECARE (2020–2023) to design a digitally enabled integrated care program aiming at preventing unplanned hospitalizations. Methods: A two-phase process with four design thinking (DT) sessions was conducted to analyse the management of complex chronic patients in the region of Catalonia (ES). In Phase I, Discovery, two DT sessions, October 2021 and February 2022, were done using as background information: i) the results of twenty structured interviews (five patients and fifteen professionals), ii) two governmental documents on regional deployment of integrated care and on the Catalan digital health strategy, respectively, and iii) the results of a cluster analysis of 761 hospitalizations. In Phase II, Confirmation, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two additional DT sessions conducted in November and December 2022. Discussion: The qualitative analysis identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during the period 2024–2025, was generated. Conclusions: A digitally enabled adaptive case management approach to foster collaborative work and personalization of care, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations. Resum Introducció: Els pacients crònics complexos són propensos a hospitalitzacions no planificades que comporten una gran càrrega per els sistemes sanitaris arreu del mon. Les intervencions per prevenir ingressos no planificats mostren resultats poc concloents pel que fa a efectivitat. Aquest estudi descriu una anàlisi qualitativa realitzada, en el marc de l’Acció Conjunta Europea JADECARE (2020–2023), per dissenyar un programa d’atenció integrada, amb suport digital, que te per objectiu prevenir les hospitalitzacions no planificades. Mètodes: L’estudi va consistir en un procés de co-disseny efectuat a partir de l’anàlisi de la gestió de pacients crònics complexos en la demarcació de Catalunya (ES). Es va efectuar en dues fases amb un total de quatre sessions de “Design Thinking (DT)”. A la Fase I, Discovery, es van fer dues sessions de DT, Octubre de 2021 i Febrer de 2022, utilitzant com a informació de fons: i) Els resultats de vint entrevistes estructurades (cinc pacients i quinze professionals), ii) Dos documents governamentals sobre el desplegament regional de l’atenció integrada i sobre l’estratègia de salut digital, respectivament, i iii) Els resultats d’una anàlisi de clústers de 761 hospitalitzacions. A la Fase II, Confirmació, vam examinar els resultats als 30 i 90 dies post-alta hospitalària de 49.604 casos en a dues sessions de DT addicionals realitzades durant els mesos de Novembre i Desembre de 2022. Discussió: L’anàlisi qualitativa va identificar: i) Insuficient personalització de les intervencions, ii) Necessitat de canvis organitzatius, iii) Immaduresa de la digitalització, i iv) Avaluació sub-óptima del desplegament dels serveis com a principals factors explicatius de la bretxa entre eficàcia i efectivitat observada en estudis previs. L’estudi proposa un programa de prevenció d’hospitalitzacions no planificades, a avaluar durant el període 2024–2025. Conclusions: Els resultats de l’anàlisi qualitativa donen suport a la modalitat de gestió adaptativa de casos, amb suport digital, per fomentar el treball col·laboratiu i la personalització de l’atenció. També plantegen la necessitat de reenginyeria dels processos clínics per assolir una prevenció eficient i basada en valors, de les hospitalitzacions no planificades en el mon real. Paraules Clau: Gestió adaptativa de casos; “Design Thinking”; Digitalització; Atenció personalitzada; Prevenció d’ingressos hospitalaris no planificats

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 preventing unplanned hospitalizations. Methods A two-phase process of structured interviews and design thinking (DT) sessions was conducted. Firstly, we assessed the management of CCP in Catalonia (ES) through twenty interviews (five patients and fifteen professionals), including the results of a cluster analysis of 761 hospitalizations, followed by two DT sessions (Oct 2021 to Feb 2022). Then, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two DT sessions with seven professionals. Discussion The co-creation process identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during 2023-2025, was generated. Conclusions A digitally enabled adaptive case management approach to foster collaborative work, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations.

Background: Indoor air quality (IAQ) is a well demonstrated actionable determinant of health status. Low-cost sensors (LCS) could enable patient-centred assessments, but real-world clinical utility is uncertain. Objective: Evaluate the feasibility, usability and clinical indications of home IAQ monitoring with LCS. Methods: We conducted a cohort study involving household continuous IAQ monitoring with LCS of 205 adults with chronic obstructive pulmonary disease, bronchiectasis or asthma. Household IAQ was profiled prospectively over a 2-month period registering concentrations of carbon dioxide, particulate matter 2.5 µm (PM _2.5 ) and formaldehyde every 10 min. For each pollutant, dwellings were classified as good, moderate or unhealthy according to the Global Open Air Quality Standards thresholds. Pulmonary exacerbations requiring unplanned hospitalisations and all-cause emergency department (ED) visits over the preceding 12 months were registered and potential relationships with household IAQ results were explored. Results: Of the 205 participants, 178 were included in the final analysis after excluding dropouts and cases with insufficient monitoring data. More than half of homes (51.7%) had at least one pollutant in an at-risk category. The burden was mostly generated by PM _2.5 : 40.1% of dwellings were classified as at risk (32.8% moderate; 7.3% unhealthy). Formaldehyde exceeded the low-risk threshold in 22 homes (12.4%). Tobacco smoking, either active or passive, was significantly associated with PM _2.5 levels (p<0.001). No relationships were found between IAQ categories and hospitalisations nor with all-cause ED visits. Conclusions: LCS are useful tools for short-term, targeted household IAQ screening in chronic respiratory patients. Indoor pollution is highly prevalent and largely PM _2.5 driven. Further research is needed to assess the short-term health impacts of these exposures. Trial registration number: NCT06421402 .

Background Community-based management of exacerbations in high-risk chronic obstructive respiratory patients remains a major challenge due to patients’ heterogeneities, co-morbidities and symptoms-based assessment of the episodes. Hybrid care interventions—combining digital tools with in-person, patient-centered care—have demonstrated efficacy in reducing unplanned hospitalizations. However, their effectiveness in real-world settings is less well established. Objectives To report the co-design process aiming to (1) characterize target candidates; and (2) adapt the implementation of a hybrid care intervention to routine clinical practice. Methods In the Integrated Health District of Barcelona-Esquerra (520 k citizens), three Plan-Do-Study-Act (PDSA) co-design cycles, each lasting six months, were conducted using a mixed-methods approach during a two-year follow-up (2024–2025) of a cohort of 205 patients with chronic obstructive pulmonary disease (COPD) and co-morbidities or severe asthma. Results By the end of PDSA cycle 3 (August 2025), profiles of high-risk candidates for the hybrid care intervention were identified. The specificities of the three intertwined components of the intervention: i) health risk assessment, ii) advanced digital support, and iii) nurse-led in person care were defined. Home-based, patient’s self-administered Oscillometry proved useful for the objective assessment and management of exacerbations. Adapting the implementation of the hybrid care intervention to local clinical workflows was identified as a priority to enable its sustainable adoption. Conclusions A personalized hybrid care intervention appears suitable for the management of heterogeneous high-risk respiratory patients. Ongoing tailored implementation during PDSA cycle 4, until February 2026, will be key for its scale up and sustainable adoption. Trial registration number NCT06421402.