A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS
by
Katie Palmer 1,*, Angelo Carfì 2, Carmen Angioletti 3, Antonella Di Paola 1, Rokas Navickas 4,5, Laimis Dambrauskas 4,5, Elena Jureviciene 4,5, Maria João Forjaz 6, Carmen Rodriguez-Blazquez 7
, Alexandra Prados-Torres 8, Antonio Gimeno-Miguel 8, Mabel Cano-del Pozo 9, María Bestué-Cardiel 9, Francisca Leiva-Fernández 10, Elisa Poses Ferrer 11, Ana M Carriazo 12, Carmen Lama 12, Rafael Rodríguez-Acuña 13, Inmaculada Cosano 14, Juan José Bedoya-Belmonte 15, Ida Liseckiene 16, Mirca Barbolini 17, Jon Txarramendieta 18, Esteban de Manuel Keenoy 18, Ane Fullaondo 18, Mieke Rijken 19,20 and Graziano Onder 21
Katie Palmer 1,*, Angelo Carfì 2, Carmen Angioletti 3, Antonella Di Paola 1, Rokas Navickas 4,5, Laimis Dambrauskas 4,5, Elena Jureviciene 4,5, Maria João Forjaz 6, Carmen Rodriguez-Blazquez 7, Alexandra Prados-Torres 8, Antonio Gimeno-Miguel 8, Mabel Cano-del Pozo 9, María Bestué-Cardiel 9, Francisca Leiva-Fernández 10, Elisa Poses Ferrer 11, Ana M Carriazo 12, Carmen Lama 12, Rafael Rodríguez-Acuña 13, Inmaculada Cosano 14, Juan José Bedoya-Belmonte 15, Ida Liseckiene 16, Mirca Barbolini 17, Jon Txarramendieta 18, Esteban de Manuel Keenoy 18, Ane Fullaondo 18, Mieke Rijken 19,20 and Graziano Onder 21
1
Department of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
2
Centro di Medicina dell’Invecchiamento, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00136 Rome, Italy
3
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
4
Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
5
Department of Biomedical Research, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
6
National School of Public Health and REDISSEC, Carlos III Institute of Health, ES-28029 Madrid, Spain
7
National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, ES-28029 Madrid, Spain
8
EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, REDISSEC, 50009 Zaragoza, Spain
9
General Directorate of Healthcare, Health Department, 50017 Zaragoza, Spain
10
Málaga-Guadalhorce Primary Care Teaching Unit, IBIMA, Andalusian Health Service, 29009 Málaga, Spain
11
Agency for Health Quality and Assessment of Catalonia (AQuAS), Government of Catalonia, 08005 Barcelona, Spain
12
Regional Ministry of Health and Families of Andalusia (CSFJA), E-41020 Seville, Spain
13
Andalusian Public Foundation Progress and Health (FPS), E-41092 Seville, Spain
14
San José de la Rinconada-Los Carteros Primary Care Center, Andalusian Health Service (Servicio Andaluz de Salud, SAS), E-41300 Seville, Spain
15
Tiro de Pichón Primary Care Center, Andalusian Health Service (Servicio Andaluz de Salud, SAS), E-29006 Málaga, Spain
16
Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
17
European Commission (DG Santè), 41225 Modena, Italy
18
Kronikgune Institute for Health Services Research, 48902 Basque Country, Spain
19
Nivel (Netherlands Institute for Health Services Research), 3513 CR Utrecht, The Netherlands
20
Department of Health and Social Management, University of Eastern Finland, FI-70210 Kuopio, Finland
21
Department of Cardiovascular, Metabolic and Aging Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(24), 5044; https://doi.org/10.3390/ijerph16245044
Received: 6 November 2019 / Revised: 27 November 2019 / Accepted: 1 December 2019 / Published: 11 December 2019
(This article belongs to the Special Issue Implementation of Interventions in Public Health)
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.
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Keywords:
multimorbidity; chronic disease; non-communicable diseases; integrated care; care model; Europe; care manager; individualized care plans; comprehensive assessment
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MDPI and ACS Style
Palmer, K.; Carfì, A.; Angioletti, C.; Di Paola, A.; Navickas, R.; Dambrauskas, L.; Jureviciene, E.; João Forjaz, M.; Rodriguez-Blazquez, C.; Prados-Torres, A.; Gimeno-Miguel, A.; Cano-del Pozo, M.; Bestué-Cardiel, M.; Leiva-Fernández, F.; Poses Ferrer, E.; Carriazo, A.M.; Lama, C.; Rodríguez-Acuña, R.; Cosano, I.; Bedoya-Belmonte, J.J.; Liseckiene, I.; Barbolini, M.; Txarramendieta, J.; de Manuel Keenoy, E.; Fullaondo, A.; Rijken, M.; Onder, G. A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS. Int. J. Environ. Res. Public Health 2019, 16, 5044.
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