National Centre of Epidemiology, Institute of Health Carlos III and CIBERNED, 28029 Madrid, Spain.
National Centre of Epidemiology, Institute of Health Carlos III and REDISSEC, 28029 Madrid, Spain.
Int J Environ Res Public Health. 2020 Jul 22;17(15):5268. doi: 10.3390/ijerph17155268.
Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention ( < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.
多种疾病共存，即一名患者同时患有多种慢性疾病，这对医疗保健系统和社会构成了巨大挑战。最近，在慢性病联合行动（Joint Action on chronic diseases）和全生命周期促进健康老龄化联合行动（promoting healthy ageing across the life cycle）中设计了综合多病种照护模式（Integrated Multimorbidity Care Model，IMCM），以确保多病种患者的照护连续性。在慢性病联合行动 CHRODIS-PLUS 项目中，该模式在西班牙、意大利和立陶宛的五个欧洲试点地区得到实施。17 名医疗保健管理人员使用慢性病照护评估工具（Assessment of Chronic Illness Care，ACIC），226 名患者使用慢性病患者照护评估工具（Patient Assessment of Care for Chronic Conditions，PACIC+），在实施前后对这些试点干预措施的效果进行了评估。干预后，ACIC 总分显著增加（从 5.23 增至 6.71， = 0.022），且不同试点地区之间存在差异。PACIC+ 总分也显著增加，从基线时的 3.25 增加到干预后的 4.03（ < 0.001），且 58%的样本认为照护得到改善。干预后 PACIC+ 评分较高与相应 PACIC+维度的基线值较低以及 ACIC 第 1 部分（交付系统组织）的变化较大有关。IMCM 的实施有助于提高多病种患者的照护质量。
