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The authors are also grateful for the support from the partners from the PAPRIKA project (https://eithealth.eu/project/paprika/).; This study has been funded by Instituto de Salud Carlos III (Spain): FIS-Smart PITeS (PI18/00841) Una manera de hacer Europa.

Analysis of institutional authors

Roca Ferrer, JordiAuthorCano IAuthorSebio RAuthorLaxe SAuthorRoca JAuthorMartinez-Palli GCorresponding Author
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Article

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case

Publicated to:International Journal Of Integrated Care. 22 (4): 1- - 2022-12-01 22(4), DOI: 10.5334/ijic.6503

Authors: Baltaxe, Erik; Cano, Isaac; Risco, Raquel; Sebio, Raquel; Dana, Fernando; Laxe, Sara; Martinez, Ramon; Ozores, Fernando; Roca, Josep; Martinez-Palli, Graciela

Affiliations

Buenaidea Creatividad & Innovac SL, Arago 184, Barcelona 08011, Catalonia, Spain - Author
CIBER of Respiratory Diseases (CIBERES), Madrid, Spain. - Author
CIBER Resp Dis CIBERES, Madrid, Spain - Author
Hosp Clin Barcelona, Anesthesiol Dept, Villarroel 170, Barcelona 08036, Spain - Author
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Anesthesiol Dept, Villarroel 170, Barcelona 08036, Catalonia, Spain - Author
Hosp Clin Barcelona, Phys Med & Rehabil Dept, Villarroel 170, Barcelona 08036, Spain - Author
Hosp Clin Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain - Author
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain - Author
Sheba Med Ctr, Inst Pulmonol Physiol & Exercise, Ramat Gan, Israel - Author
Stimulo Design SL, Placa Damia Mateu 1, Llinars Des Valles 08450, Catalonia, Spain - Author
Univ Barcelona UB, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Catalonia, Spain - Author
Univ Barcelona UB, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain - Author
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Abstract

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 facilitate site transferability.An implementation research approach with a population-based orientation, combining experience-based co-design and quality improvement methodologies, was applied. We undertook several design-thinking sessions (Oct-Nov 2017, June 2021 and December 2021) to generate and follow-up a work plan fostering service scalability. The implementation process was assessed using the Comprehensive Framework for Implementation Research, leading to the identification of key performance indicators.Personalization and modularity of the intervention according to patients' surgical risk were identified as core traits to enhance patients' adherence and value generation. A digitally enabled service workflow, with an adaptive and collaborative case management approach, should combine face-to-face and remotely supervised sessions with intelligent systems for patients' and professionals' decision support. The business model envisages operational costs financed by savings generated by the service.Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability.Copyright: © 2022 The Author(s).

Keywords
designguidelinesmhealthmindfulnessnutritional optimizationperioperative carephysical activityprehabilitationqualityrisk patientssurgery enhanced recoveryAdoptionAdultArticleCase managementCo-creationDecision support systemEfficacy-effectiveness gapFollow upHumanIdentification keyImplementation scienceMhealthMindfulnessNutritional optimizationPerformance indicatorPhysical activityPrehabilitationPreoperative exerciseRisk assessmentSurgical riskThinkingTotal quality managementWorkflow

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal International Journal Of Integrated Care due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Sociology and Political Science.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.49. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.37 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 9.3 (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-18, the following number of citations:

  • WoS: 10
  • Scopus: 10
  • Europe PMC: 8
  • OpenCitations: 12
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-18:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 43.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 42 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 2.7.
  • The number of mentions on the social network X (formerly Twitter): 4 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Israel.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Martínez Pallí, Graciela).

the author responsible for correspondence tasks has been Martínez Pallí, Graciela.