Fenna R M Leijten1, Verena Struckmann2, Ewout van Ginneken3, Thomas Czypionka4, Markus Kraus4, Miriam Reiss4, Apostolos Tsiachristas5, Melinde Boland6, Antoinette de Bont6, Roland Bal6, Reinhard Busse2, Maureen Rutten-van Mölken7. 1. Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands. Electronic address: leijten@bmg.eur.nl. 2. Department of Health Care Management, Berlin University of Technology, Germany. 3. European Observatory on Health Systems and Policies, Berlin University of Technology, Department of Health Care Management, Germany. 4. Institute for Advanced Studies, Vienna, Austria. 5. Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands; Health Economics Research Centre, University of Oxford, UK. 6. Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands. 7. Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, the Netherlands.
Abstract
BACKGROUND: The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. METHODS: A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. DISCUSSION: meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. RESULTS: In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. CONCLUSION: The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.
BACKGROUND: The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. METHODS: A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. DISCUSSION: meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. RESULTS: In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. CONCLUSION: The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.
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