Care models for Individuals with Chronic Multimorbidity: Elements, Impact, Implementation Challenges and Facilitators

Abstract

Background Patients with multiple long-term conditions requires specialized care models to manage their complex health needs. Understanding the existing care models is essential to address the multifaceted effects of multimorbidity effectively. However, current literature lacks a comprehensive overview of the essential components, impacts, challenges, and facilitators of these care models, prompting this scoping review. Methods We conducted a scoping review on Care models for chronic multimorbidity. We conducted the review in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews guideline. Our search encompassed articles from PubMed, Web of Science, EMBASE, SCOPUS, and Google Scholar. We thoroughly reviewed reference lists to identify relevant articles. The most recent database search was conducted on February 12, 2024. We utilized the World Health Organization’s health system framework, which comprises six building blocks (service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance) and eight key characteristics of good service delivery models (access, coverage, quality, safety, improved health, responsiveness, social and financial risk protection, and improved efficiency). We qualitatively synthesized findings to identify components, impacts, barriers, and facilitators of care models. Results A care model represents various collective interventions in the healthcare delivery aimed at achieving desired outcomes. The names of these care models are derived from core activities or major responsibilities, involved healthcare teams, diseases conditions, eligible clients, purposes, and care settings. Notable care models include the Integrated, Collaborative, Integrated-Collaborative, Guided, Nurse-led, Geriatric, and Chronic care models, as well as All-inclusive Care Model for the Elderly, IMPACT clinic, and Geriatric Patient-Aligned Care Teams (GeriPACT). Additionally, other care models (include Care Management Plus, Value Stream Mapping, Preventive Home Visits, Transition Care, Self-Management, and Care Coordination) have supplemented the main ones. Essential facilitators for the effective implementation of care models include shared mission, system and function integration, availability of resources, and supportive tools. The implementation of these care models has been shown to improve the quality of care (such as access, patient-centeredness, timeliness, safety, efficiency), cost of healthcare, and quality of life for patients. Conclusions The review reveals that each model, whether integrated, collaborative, nurse-led, or specific to chronic and geriatric care, has potential for enhancing quality of care, health outcomes, cost efficiency, and patient satisfaction. Effective implementation of these models requires careful recruitment of eligible clients, appropriate selection of service delivery settings, and robust organizational arrangements involving leadership roles, healthcare teams, financial support, and health information systems. The distinct team compositions and their roles in service provision processes differentiate care models.