A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS
A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS
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DOI：
10.3390/ijerph16245044
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发表时间：
2019-12-02
影响因子：
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通讯作者：
Onder, Graziano
中科院分区：
文献类型：
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作者：
Palmer, Katie;Carfi, Angelo;Onder, Graziano
患有多发性硬化症（定义为多种慢性疾病的共同发生）的患者经常经历分散的护理，这增加了负面结果的风险。最近提出的综合多产妇护理模式旨在克服与分散护理有关的许多问题。在联合行动CHRODIS-PLUS的背景下，为护理模式制定了一种实施方法，目前正在五个地点进行试点。我们的目标是（1）解释用于实施护理模式的方法，（2）描述试点地点如何适应和应用拟议的方法。该模式正在西班牙（安达卢西亚和阿拉贡）、立陶宛（维尔纽斯和考纳斯）和意大利（罗马）实施。每个地点的当地执行工作组采用相同的方法步骤，根据当地的需要、目标和资源调整了该模式：（1）范围分析;（2）情况分析-“优势、劣势、机会、威胁”分析;（3）制定和改进执行方法;（4）最后制定行动计划。这一共同实施战略表明了如何根据地方和区域的具体情况调整护理模式。在实施后阶段对共同的关键结果指标进行分析将有助于证明临床有效性，并强调在不同国家和临床环境中采用共同的综合多学科护理模式的任何困难。
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.