A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS

Katie Palmer, Angelo Carfì, Carmen Angioletti, Antonella Di Paola, Rokas Navickas, Laimis Dambrauskas, Elena Jureviciene, Maria João Forjaz, Carmen Rodriguez-Blazquez, Alexandra Prados-Torres, Antonio Gimeno-Miguel, Mabel Cano-del Pozo, María Bestué-Cardiel, Francisca Leiva-Fernández, Elisa Poses Ferrer, Ana M Carriazo, Carmen Lama, Rafael Rodríguez-Acuña, Inmaculada Cosano, Juan José Bedoya-Belmonte, Ida Liseckiene, Mirca Barbolini, Jon Txarramendieta, Esteban de Manuel Keenoy, Ane Fullaondo, Mieke Rijken and Graziano Onder
Additional contact information
Katie Palmer: Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
Angelo Carfì: Centro di Medicina dell’Invecchiamento, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00136 Rome, Italy
Carmen Angioletti: Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore and Centro di Medicina dell’Invecchiamento, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00136 Rome, Italy
Antonella Di Paola: Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
Rokas Navickas: Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
Laimis Dambrauskas: Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
Elena Jureviciene: Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
Maria João Forjaz: National School of Public Health and REDISSEC, Carlos III Institute of Health, ES-28029 Madrid, Spain
Carmen Rodriguez-Blazquez: National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, ES-28029 Madrid, Spain
Alexandra Prados-Torres: EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, REDISSEC, 50009 Zaragoza, Spain
Antonio Gimeno-Miguel: EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, REDISSEC, 50009 Zaragoza, Spain
Mabel Cano-del Pozo: General Directorate of Healthcare, Health Department, 50017 Zaragoza, Spain
María Bestué-Cardiel: General Directorate of Healthcare, Health Department, 50017 Zaragoza, Spain
Francisca Leiva-Fernández: Málaga-Guadalhorce Primary Care Teaching Unit, IBIMA, Andalusian Health Service, 29009 Málaga, Spain
Elisa Poses Ferrer: Agency for Health Quality and Assessment of Catalonia (AQuAS), Government of Catalonia, 08005 Barcelona, Spain
Ana M Carriazo: Regional Ministry of Health and Families of Andalusia (CSFJA), E-41020 Seville, Spain
Carmen Lama: Regional Ministry of Health and Families of Andalusia (CSFJA), E-41020 Seville, Spain
Rafael Rodríguez-Acuña: Andalusian Public Foundation Progress and Health (FPS), E-41092 Seville, Spain
Inmaculada Cosano: San José de la Rinconada-Los Carteros Primary Care Center, Andalusian Health Service (Servicio Andaluz de Salud, SAS), E-41300 Seville, Spain
Juan José Bedoya-Belmonte: Tiro de Pichón Primary Care Center, Andalusian Health Service (Servicio Andaluz de Salud, SAS), E-29006 Málaga, Spain
Ida Liseckiene: Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
Mirca Barbolini: European Commission (DG Santè), 41225 Modena, Italy
Jon Txarramendieta: Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain
Esteban de Manuel Keenoy: Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain
Ane Fullaondo: Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain
Mieke Rijken: Nivel (Netherlands Institute for Health Services Research), 3513 CR Utrecht, The Netherlands
Graziano Onder: Department of Cardiovascular, Metabolic and Aging Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy

IJERPH, 2019, vol. 16, issue 24, 1-18

Abstract: Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis—“strengths, weaknesses, opportunities, threats” (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings.

Keywords: multimorbidity; chronic disease; non-communicable diseases; integrated care; care model; Europe; care manager; individualized care plans; comprehensive assessment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (8)

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