Stewart Moira, Fortin Martin
Affiliations: Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Family Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre de santé et de services sociaux de Chicoutimi (Fortin), Unité de médecine de famille, Chicoutimi, Que.
CMAJ Open. 2017 May 9;5(2):E365-E372. doi: 10.9778/cmajo.20160097.
The high prevalence of multimorbidity necessitates rethinking of the health care system. The overarching goal of the Patient-Centred Innovations for Persons with Multimorbidity program is to build on existing structures and find and evaluate patient-centred innovations relevant to multimorbidity.
We describe the protocol for a proposed multijurisdictional (Quebec and Ontario) concurrent triangulation mixed-methods study. In both provinces, a qualitative descriptive study will be used to explore innovations in patient-centred multimorbidity care. Two randomized controlled trials, 1 in either province, will evaluate the innovations in a wait-list-controlled design using patient-reported outcomes. An additional control group, matched on age, sex, enrolment/index date (± 3 mo) and propensity score, will be created with the use of health administrative data. Patients will be 18-80 years of age and will have 3 or more chronic conditions. The innovations will have elements of relevance to multimorbidity care, patient-centred partnerships and integration of care. The primary outcome measures will be 2 patient-reported outcomes: patient education and self-efficacy. Secondary outcomes will include patient-reported health status, quality of life, psychological distress and health behaviours, and costs of care.
This protocol describes a mixed-method study in 2 jurisdictions. The studies will answer the questions of what innovations work and how they work for patients, health care professionals and policy-makers. ClinicalTrials.gov, no NCT02789800 (Quebec Trial), NCT02742597 (Ontario Trial).
多重疾病的高患病率使得有必要重新思考医疗保健系统。以患者为中心的多重疾病患者创新项目的总体目标是在现有结构的基础上，寻找并评估与多重疾病相关的以患者为中心的创新措施。
我们描述了一项拟议的多辖区（魁北克省和安大略省）同步三角测量混合方法研究的方案。在这两个省份，将采用定性描述性研究来探索以患者为中心的多重疾病护理方面的创新措施。两项随机对照试验，分别在其中一个省份进行，将采用等待名单对照设计，利用患者报告的结果来评估这些创新措施。将利用卫生行政数据创建一个额外的对照组，该对照组在年龄、性别、登记/索引日期（±3个月）和倾向得分方面进行匹配。患者年龄将在18至80岁之间，且患有3种或更多慢性疾病。这些创新措施将包含与多重疾病护理、以患者为中心的伙伴关系和护理整合相关的要素。主要结局指标将是2项患者报告的结果：患者教育和自我效能感。次要结局将包括患者报告的健康状况、生活质量、心理困扰和健康行为以及护理成本。
本方案描述了一项在两个辖区开展的混合方法研究。这些研究将回答哪些创新措施有效以及它们如何对患者、医疗保健专业人员和政策制定者发挥作用的问题。ClinicalTrials.gov，编号NCT02789800（魁北克试验），NCT02742597（安大略试验）。
