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

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.

Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions

“…Several trials are currently ongoing that may provide useful insight into how the various components of integrated care models can be applied in different European countries. For example, Joint Action CHRODIS+ is currently piloting an integrated care model for multimorbid patients in five European sites in three countries (Italy, Lithuania and, Spain) with the aim to develop an implementation model that can be adapted according to local and national needs [34]. In addition, findings from the Spanish Multi-PAP project described above are expected soon [28].…”

Health Promotion Interventions: Lessons from the Transfer of Good Practices in CHRODIS-PLUS

“…Moreover, the implementation process was limited to 12 months so as to align with the timeframe of the three-year CHRODIS-PLUS joint action. Therefore, various aspects might reflect this relatively short intervention period [21]. However, our findings are from projects that were implemented in significantly different contexts (e.g., an Irish program in Lithuania and Spain) and, therefore, represents a worthwhile addition to the literature on health promotion implementation.…”

“…There are several strengths of the implementation strategy [21]. We applied a framework that followed a standardized procedure that each local site followed and used to transfer according to their attributes, capacity, and requirements.…”

“…It was designed to be feasible enough according to the resources of the project (see Figure 1). The strategy consists of four stages that will be followed by all implementation sites [20,21] Context is defined here as the local setting, i.e., the local organization in which the implementation of a good practice takes place. The setting has its inner context with people, guidelines, decision-making structures, etc.…”

A New Personalised Telehealth Model in Chronic Pediatric Diseases and Disability During The COVID-19 ERA

“…Establishing the Multidisciplinary and Multiprofessional Team, providing patient platforms to exchange information between patients and their care providers and introducing the gure of the case manager or of a dedicated nurse has been essential to signi cantly improve patient's and caregivers' perception of quality of care and compliance with the therapeutic process with a consequent equitable increase in access to care (8)(9)(10).…”