Jonathan Stokes1,2, Mei-See Man3, Bruce Guthrie4, Stewart W Mercer5, Chris Salisbury3, Peter Bower6. 1. NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom jonathan.m.stokes@manchester.ac.uk. 2. Centre for Health Economics, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom. 3. Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. 4. Quality, Safety and Informatics Research Group, University of Dundee, Dundee, United Kingdom. 5. General Practice and Primary Care, Institute for Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom. 6. NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
Abstract
PURPOSE: Multimorbidity challenges health systems globally. New models of care are urgently needed to better manage patients with multimorbidity; however, there is no agreed framework for designing and reporting models of care for multimorbidity and their evaluation. METHODS: Based on findings from a literature search to identify models of care for multimorbidity, we developed a framework to describe these models. We illustrate the application of the framework by identifying the focus and gaps in current models of care, and by describing the evolution of models over time. RESULTS: Our framework describes each model in terms of its theoretical basis and target population (the foundations of the model) and of the elements of care implemented to deliver the model. We categorized elements of care into 3 types: (1) clinical focus, (2) organization of care, (3) support for model delivery. Application of the framework identified a limited use of theory in model design and a strong focus on some patient groups (elderly, high users) more than others (younger patients, deprived populations). We found changes in elements with time, with a decrease in models implementing home care and an increase in models offering extended appointments. CONCLUSIONS: By encouragin greater clarity about the underpinning theory and target population, and by categorizing the wide range of potentially important elements of an intervention to improve care for patients with multimorbidity, the framework may be useful in designing and reporting models of care and help advance the currently limited evidence base.
PURPOSE: Multimorbidity challenges health systems globally. New models of care are urgently needed to better manage patients with multimorbidity; however, there is no agreed framework for designing and reporting models of care for multimorbidity and their evaluation. METHODS: Based on findings from a literature search to identify models of care for multimorbidity, we developed a framework to describe these models. We illustrate the application of the framework by identifying the focus and gaps in current models of care, and by describing the evolution of models over time. RESULTS: Our framework describes each model in terms of its theoretical basis and target population (the foundations of the model) and of the elements of care implemented to deliver the model. We categorized elements of care into 3 types: (1) clinical focus, (2) organization of care, (3) support for model delivery. Application of the framework identified a limited use of theory in model design and a strong focus on some patient groups (elderly, high users) more than others (younger patients, deprived populations). We found changes in elements with time, with a decrease in models implementing home care and an increase in models offering extended appointments. CONCLUSIONS: By encouragin greater clarity about the underpinning theory and target population, and by categorizing the wide range of potentially important elements of an intervention to improve care for patients with multimorbidity, the framework may be useful in designing and reporting models of care and help advance the currently limited evidence base.
Authors: Catherine Henderson; Martin Knapp; José-Luis Fernández; Jennifer Beecham; Shashivadan P Hirani; Martin Cartwright; Lorna Rixon; Michelle Beynon; Anne Rogers; Peter Bower; Helen Doll; Ray Fitzpatrick; Adam Steventon; Martin Bardsley; Jane Hendy; Stanton P Newman Journal: BMJ Date: 2013-03-20
Authors: Karen Barnett; Stewart W Mercer; Michael Norbury; Graham Watt; Sally Wyke; Bruce Guthrie Journal: Lancet Date: 2012-05-10 Impact factor: 79.321
Authors: Maria Panagioti; Jonathan Stokes; Aneez Esmail; Peter Coventry; Sudeh Cheraghi-Sohi; Rahul Alam; Peter Bower Journal: PLoS One Date: 2015-08-28 Impact factor: 3.240
Authors: Hanne Birke; Ramune Jacobsen; Alexandra Br Jønsson; Ann Dorrit Kristiane Guassora; Marie Walther; Thomas Saxild; Jannie T Laursen; Maria Helena Dominquez Vall-Lamora; Anne Frølich Journal: J Comorb Date: 2020-07-30
Authors: Magdalena Rzewuska; Ana Carolina Guidorizzi Zanetti; Zoë C Skea; Leonardo Moscovici; Camila Almeida de Oliveira; João Mazzoncini de Azevedo-Marques Journal: PLoS One Date: 2021-05-13 Impact factor: 3.240
Authors: Jonathan Stokes; Søren Rud Kristensen; Kath Checkland; Sudeh Cheraghi-Sohi; Peter Bower Journal: BMC Health Serv Res Date: 2017-08-03 Impact factor: 2.655
Authors: Katherine Chaplin; Peter Bower; Mei-See Man; Sara T Brookes; Daisy Gaunt; Bruce Guthrie; Cindy Mann; Stewart W Mercer; Imran Rafi; Alison R G Shaw; Chris Salisbury Journal: BMJ Open Date: 2018-08-29 Impact factor: 2.692