Doessing Anne, Burau Viola
VIA University College, School of Continuing Education, Centre for Leadership and Organisation Development (CLOU), Aarhus, Denmark.
J Comorb. 2015 Apr 16;5:15-28. doi: 10.15256/joc.2015.5.39. eCollection 2015.
A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework.
The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals.
The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care.
The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity).
In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.
全球医疗保健系统面临的一个关键挑战是患有多种疾病的患者数量众多；尽管如此，大多数系统仍在单一疾病框架内组织。
本研究探讨两个问题：患有多种疾病的患者护理协调的特征和前提条件；以及在医疗机构和医疗专业人员层面促进或抑制护理协调的因素。
该分析基于一项范围界定研究，将系统文献检索与定性主题分析相结合。检索于2013年11月进行，包括PubMed、CINAHL和科学引文索引数据库，以及Cochrane图书馆、相关组织的网站，并手动检索参考文献列表。分析包括来自工业化国家、采用多种设计、以英语、德语和斯堪的纳维亚语撰写的研究，这些研究聚焦于多种疾病/合并症以及综合护理的协调。
分析纳入了226项已识别研究中的47项。出现的核心主题是复杂性。这既涉及患有多种疾病患者的特定医疗状况（病例复杂性），也涉及医疗机构和医疗专业人员层面的护理提供组织（护理复杂性）。
在如何进行护理协调方面，一种方法是降低复杂性，另一种方法是接受复杂性。无论哪种方式，未来的研究都必须在复杂性问题上采取更明确的立场，并且更好地理解专业人员的作用，这是开发新的护理协调干预措施的前提条件。
