The Gothenburg model of Person-Centred Care (PCC) is an evidence-based intervention shown to improve care and health outcomes while maintaining cost. Other health systems could benefit from its sustainable implementation. The WE-CARE implementation framework, adapted by COSTCares, provides a base set of enablers and outcomes recommended for the design and evaluation of PCC. The methodology is extended using implementation science to systematically address contextual factors at different levels. Evidence-based frameworks, such as the Consolidated Framework for Implementation Research (CFIR), for example, and hybrid effectiveness-implementation study designs can be used. Additional enablers to consider when designing and evaluating PCC implementation strategies are discussed. The outcomes of quality of care and cost can be addressed using a Value for Money (VfM) framework. Various VfM methods and analysis models can be incorporated into PCC implementation research design in order to influence policy makers and health system decision makers towards the sustainable uptake of PCC.

Background/Objectives: Colorectal cancer is the most frequently diagnosed cancer and second by mortality among all cancers in Croatia. The Organized National Colorectal Cancer Screening Program was introduced by the government in 2007. It targets individuals aged 50–74 years with a biennial screening with a guaiac fecal occult blood test (gFOBT). The aim of this study is to analyze the costs associated with colorectal cancer in Croatia and to compare the cost-effectiveness of three screening strategies: no screening, biennial gFOBT, and biennial fecal immunochemical testing (FIT). Patients and methods: A model was developed to compare the three screening scenarios. The model simulated a cohort of 10,000 patients aged 50 years without colorectal cancer. Health outcomes and associated costs were projected over a five-year time horizon. The model outcomes include the number of newly diagnosed colorectal cancer cases, number of colorectal cancer-related deaths, life-years gained, and costs per life-year gained. Results: The average five-year costs per patient for the treatment of advanced cancer are EUR 39,802, which is substantially higher than the average costs of EUR 16,897 per patient across all stages. The implemented model indicates that both screening options yielded improved health outcomes at lower costs compared with no screening. FIT is considered the preferred screening option due to its higher sensitivity, greater health outcomes, and lower costs relative to gFOBT. Conclusions: The introduction of FIT screening instead of gFOBT could increase screening uptake for colorectal cancer, improve health outcomes, and reduce healthcare expenditures and the economic burden associated with colorectal cancer in Croatia.

Povećanje učinkovitosti i uspostavljanje financijske održivosti bolničkog zdravstvenog sustava u Republici Hrvatskoj temeljne su odrednice Nacionalnog plana razvoja bolnica. Cilj je rada prikazati aktivnosti bolničke mreže u Republici Hrvatskoj između 2017. i 2021. godine u odnosu na specifične modele plaćanja zdravstvenih usluga i zahtjeve za bolničkim uslugama na temelju tipa upućivanja. Potencijal sekundarne upotrebe prikupljenih podataka za unapređenje efikasnosti i kvalitete bolničkog zdravstvenog sustava analiziran je na temelju podataka za pet specifičnih indikatora. Istraživanje je retrospektivno, a analizom su obuhvaćeni podaci iz baze računa Hrvatskog zavoda za zdravstveno osiguranje. Odabrani vremenski okvir kvantificirao je smanjenje aktivnosti bolnica za sve aspekte liječenja tijekom trajanja COVID-19 pandemije uz manje zahtjeva za bolničkim uslugama na temelju upućivanja iz primarne zdravstvene zaštite. Specifičnost i upotrebljivost dostupnih podataka u reformi bolničkog zdravstvenog sustava nužno je iskoristiti za izgradnju analitičkih alata koji će određivati ne samo smjer razvoja mreže bolnica, već i cjelokupnog zdravstvenog sustava u Republici Hrvatskoj.

Nacionalni program ranog otkrivanja raka vrata maternice se kao organizirani nacionalni probir provodio od 1. prosinca 2012. godine do 2016. godine (u daljnjem tekstu: Program) Papa-testom kao probirnom metodom. Istovremeno se u Republici Hrvatskoj provodi i oportunistički probir istim testom unazad više desetljeća i provode ga timovi primarne ginekologije. Iako je jedan od ciljeva organiziranog nacionalnog probira ukidanje oportunističkog probira, jedna od privremenih mogućnosti poboljšanja probira je integracija organiziranog nacionalnog probira i oportunističkog probira s obzirom na dostupnost djelatnosti zdravstvene zaštite žena na području cijele države kroz timove primarne ginekologije – do postizanja navedenog cilja. Za navedeno je preduvjet trenutno dostupno kvalitetno informatičko rješenje. Informatički program koji je izgrađen na zajedničkoj platformi za sva tri nacionalna programa ranog otkrivanja raka (dojke, debelog crijeva i vrata maternice) povezan je sa sustavima CEZIH i ZOROH koji su važan izvor podataka o osobama, a trenutno je u potpunosti funkcionalan s definiranim poslovnim procesima napisanim u protokolima za pojedini program. Nacionalni program provodi se na način da se pisanim pozivom pozivaju sve žene u dobi od 25 do 64 godine uz interval probira od 3 godine od strane županijskih zavoda za javno zdravstvo, s time da su (osnovom baze računa HZZO-a) privremeno odgođene žene koje su napravile Papa-test unutar sustava javnog zdravstva u zadnjih godinu dana. Uz poziv se dostavlja i ime izabranog ginekologa, te u slučaju da je žena neopredijeljena, tri najbliža ginekologa koja mogu primati pacijentice. Žena se s pozivom (koji sadrži i kupovnice) javlja ginekologu, uzme se uzorak i pošalje u citološki laboratorij te se nalaz, putem novog sustava, dostavlja nadležnom ginekologu. Promjena u sustavu organiziranog nacionalnog probira bila bi i da, s obzirom na to da je dostupna informacija (i podsjetnik) od strane županijskog zavoda (kao i alternativni način poziva koji odabere žena), ginekolog provodi pozivanje žena opredijeljenih za njegov tim. Za žene koje nemaju izabranog ginekologa, pozive (uz evidenciju u informatičkom sustavu) šalju, kao i do sada, pisanim putem (ili drugim ako se žena odlučila za alternativni način slanja) timovi županijskih zavoda za javno zdravstvo s popisom triju ginekologa za koje se žena može opredijeliti. Žena ili izabere preporučenog doktora i postaje dijelom njegove populacije ili, ako ne želi, uzme se uzorak u određenoj ginekološkoj ordinaciji i napravi Papa-test, a žena ostaje neopredijeljena. Citološkim laboratorijima postupak ostaje isti za Papa-test. Dodatno testiranje na humani papiloma-virus (HPV) preporučuje se za žene u dobi od 30 do 65 godina, uzimajući u obzir status cijepljenja protiv HPV-a, a proces propisivanja, provedbe i integracije informacija je isti kao i za Papa-test. Integracijom provedbe povećala bi se odgovornost ginekologa kojima je ovo jedna od osnovnih preventivnih aktivnosti te bi se dodatno potaknule neopredijeljene žene da izaberu ginekologa čime bi se osigurala pokrivenost što većeg postotka populacije žena primarnom ginekologijom.

Background/Objectives Colorectal cancer is a most common cancer by incidence and second by mortality among all cancers in Croatia. Organized National Colorectal Cancer Screening Program was adopted by government in 2007 and targets population aged 50-74 years. Every 2 years about 1,300,000 people are invited by letter to screening using gFOBT sent by preventive medicine team from county public health institutes. Citizens with a positive FOBT result are notified by telephone and referred for colonoscopy via the screening registry's electronic ordering system. They also receive instructions on how to prepare for the examination, and instructions by mail afterwards. Their family doctor is informed about this by letter and asked for their support if additional preparations of their patients are needed so that a polypectomy can be performed in the same procedure, if necessary. Previous studies have shown that, in addition to reducing mortality from colorectal cancer, money is saved by reducing the need for treatment advanced cancer or cancer in general. There is evidence that screening with fecal immunochemical test (FIT) achieves higher participation rates and much colorectal cancer patients detected. Given that the participation rate in Croatia is lower than desired, the aim of this study was to analyze the costs of colorectal cancer treatment and screening and compare three screening scenarios in terms of cost-effectiveness: no screening, biennial gFOBT test for people aged 50 to 74 years, and biennial FIT for people aged 50 to 74 years. Patients and methods: To compare the three scenarios, we developed a model based on the projection of 10,000 patients without colorectal cancer at age 50 and their health outcomes with associated costs over the next five years. The projected outcomes over the five years included treatment costs, number of new colorectal cancer patients, number of colorectal cancer deaths, life-years gained and costs per life-year gained. Results: Costs per patient five years after diagnosis for cost of advanced cancer treatment are 39,802€ and are significantly higher than costs of 16,732€ for non-advanced cases. The implemented model shows that screening options for colorectal cancer provide better health outcomes at lower costs compared to no screening. FIT is considered the preferred screening option due to its better sensitivity and better health outcomes and lower costs compared to gFOBT. Conclusions: Since the introduction of FIT screening instead of gFOBT could increase the proportion of people screened with the screening test, it would improve health outcomes and reduce health costs and the economic burden associated with colorectal cancer in Croatia.