Transforming heart failure care in the Basque Country through value-based integrated care
Abstract
Issue/problem: Heart failure is a major cause of hospitalisation and health system burden in Europe, particularly among older populations. In the Basque Country (Spain), prevalence reaches 6.8% and 16.1% among those aged ≥75. Fragmentation across care levels limits continuity of care, patient experience and efficiency. Integrated, value-based care pathways are needed to improve outcomes and sustainability, with relevance for other European health systems.
Description of the practice: This implementation study is part of the EU4Health Joint Action JACARDI (2023–2027). An integrated heart failure (HF) care pathway was co-designed and implemented across 13 Integrated Healthcare Organisations in the Basque Country. This initiative involves clinicians, managers, community actors, patients and caregivers. It includes standardised clinical pathways, integration into a unified electronic health record, inclusion of social prescribing and self-management, and patient-centred care training. An evaluation framework based on implementation science and value-based care was developed.
Results: Preliminary results show:
- Implementation across 13 organisations with multidisciplinary engagement.
- Coverage of > 35,000 patients within the scope of the HF pathway.
- Deployment of standardised pathways and digital integration into electronic records.
- Training of healthcare professionals and facilitators.
- Establishment of an evaluation framework including patient-reported outcomes and experience measures.
- Introduction of a sex and gender perspective to promote more equitable care.
Lessons: Large-scale implementation of integrated, value-based care is feasible with strong governance, co-design and policy alignment. Implementation science and digital tools support adoption and scalability. Incorporating patient-reported outcomes and a gender perspective strengthens equity. This practice is transferable to other settings aiming to improve chronic care and system efficiency.
Key messages: • Implementing integrated, value-based care pathways for heart failure can improve coordination, patient-centred care and system efficiency on a large scale.
• Incorporating implementation science, digital tools and a gender perspective can improve equity and support the sustainable transformation of chronic care systems.
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BibTeX
@article{zabala2026transforming,
title = {{Transforming heart failure care in the Basque Country through value-based integrated care}},
author = {J I Zabala and A Gandara and A Lafuente and R Abad and D Santano and Y Hamu and I Erreguerena and A Fullaondo},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1074},
url = {https://doi.org/10.1093/eurpub/ckag169.1074},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Transforming heart failure care in the Basque Country through value-based integrated care
AU - J I Zabala
AU - A Gandara
AU - A Lafuente
AU - R Abad
AU - D Santano
AU - Y Hamu
AU - I Erreguerena
AU - A Fullaondo
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1074
UR - https://doi.org/10.1093/eurpub/ckag169.1074
AB - Issue/problem: Heart failure is a major cause of hospitalisation and health system burden in Europe, particularly among older populations. In the Basque Country (Spain), prevalence reaches 6.8% and 16.1% among those aged ≥75. Fragmentation across care levels limits continuity of care, patient experience and efficiency. Integrated, value-based care pathways are needed to improve outcomes and sustainability, with relevance for other European health systems. Description of the practice: This implementation study is part of the EU4Health Joint Action JACARDI (2023–2027). An integrated heart failure (HF) care pathway was co-designed and implemented across 13 Integrated Healthcare Organisations in the Basque Country. This initiative involves clinicians, managers, community actors, patients and caregivers. It includes standardised clinical pathways, integration into a unified electronic health record, inclusion of social prescribing and self-management, and patient-centred care training. An evaluation framework based on implementation science and value-based care was developed. Results: Preliminary results show: - Implementation across 13 organisations with multidisciplinary engagement. - Coverage of > 35,000 patients within the scope of the HF pathway. - Deployment of standardised pathways and digital integration into electronic records. - Training of healthcare professionals and facilitators. - Establishment of an evaluation framework including patient-reported outcomes and experience measures. - Introduction of a sex and gender perspective to promote more equitable care. Lessons: Large-scale implementation of integrated, value-based care is feasible with strong governance, co-design and policy alignment. Implementation science and digital tools support adoption and scalability. Incorporating patient-reported outcomes and a gender perspective strengthens equity. This practice is transferable to other settings aiming to improve chronic care and system efficiency. Key messages: • Implementing integrated, value-based care pathways for heart failure can improve coordination, patient-centred care and system efficiency on a large scale. • Incorporating implementation science, digital tools and a gender perspective can improve equity and support the sustainable transformation of chronic care systems.
SN - 1101-1262
SN - 1464-360X
ER -