Integrated care innovations for patients with multimorbidity: A scoping review

ABSTRACT

Introduction: Demographic and epidemiological challenges are demanding deep transformation within health systems. The Basque Health System has introduced innovative initiatives to deal with this reality, particularly focused on patients with multiple chronic conditions. This review intends to identify and summarize the existing evidence on the effectiveness and cost-effectiveness of these innovations developed in the Basque Country focused on complex chronic, frail, and end-of-life patients.

Methods: A scoping review of literature was undertaken in PubMed database and gray literature for data published from 2009 to 2016 on clinical management innovative approaches related to complex chronic, frail, and end-of-life patients in the Basque Country. Selected papers were analyzed by study population, reported outcomes, study period, and setting.

Results: 12 studies corresponding to 9 initiatives have been included and analyzed in the review. Results show that interventions had been effective in the achievement of their objectives and therefore, care for these targeted patients has improved. Only 3 out of 12 papers report results on cost-effectiveness, 2 presenting it as cost-effective and one not.

Conclusions: There is a consistent pattern on the benefits of implementing specific care management programs targeting these complex chronic, frail, or end-of-life patients.

KEYWORDS:

• Multimorbidity
• complex chronic patients
• frailty
• end-of-life
• care management
• Basque Country

Acknowledgements

We thank Daniel Lerner, PhD for assistance with the revision of the content and grammar and for his comments that greatly improved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Maider Urtaran Laresgoiti is a project leader and researcher at Healthcare Management Unit, University of Deusto. He holds a degree in Business Administration and Management and a Master's degree in Health Management from the University of Deusto. Her interests focus on health policy, access to care, and community health.

Roberto Nuño Solinis, is the director at the Healthcare Management Unit, University of Deusto. Roberto does research in Health Economics, and in the application of Management theories in healthcare. Areas of interest: integrated care; chronic disease management; multimorbidity; innovation and implementation research.

Additional information

Funding

This work was supported by the Robert Wood Johnson Foundation, under Grant No. 73590.