Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
BMJ Open. 2020 Oct 10;10(10):e037547. doi: 10.1136/bmjopen-2020-037547.
To measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries.
A discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity.
Preference data collected in Austria (AT), Croatia (HR), Germany (DE), Hungary (HU), the Netherlands (NL), Norway (NO), Spain (ES), and UK.
Patients with multimorbidity, partners and other informal caregivers, professionals, payers and policymakers.
Preferences of participants regarding outcomes of integrated care described as health/well-being, experience with care and cost outcomes, that is, physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and total costs. Each outcome had three levels of performance.
5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological well-being and continuity of care. Continuity of care also entered the top-three of professionals, payers and policymakers in four countries (AT, DE, HR and HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL and NO and higher weights to person-centredness in AT, DE, ES and HU. Payers and policymakers assigned higher weights than patients to costs, but these weights were relatively low.
The well-being outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision-making, whereby efforts to improve well-being and person-centredness should not divert attention from improving physical functioning.
衡量 8 个欧洲国家共病患者综合护理结果的相对偏好，并将其与这些国家内其他利益相关者的偏好进行比较。
在每个国家进行离散选择实验（DCE），要求受访者在两种共病患者的综合护理方案之间进行选择。
在奥地利（AT）、克罗地亚（HR）、德国（DE）、匈牙利（HU）、荷兰（NL）、挪威（NO）、西班牙（ES）和英国（UK）收集偏好数据。
共病患者、其伴侣和其他非正式照护者、专业人员、支付者和政策制定者。
参与者对综合护理结果的偏好，这些结果描述为健康/幸福感、护理体验和成本结果，即身体机能、心理幸福感、社会关系和参与、生活享受、韧性、以患者为中心、护理连续性和总费用。每个结果都有三个绩效水平。
5122 名受访者完成了 DCE。在所有国家，共病患者以及大多数其他利益相关者群体，都将（第二）最高的偏好赋予了生活享受。患者的前三个最常包括身体机能、心理幸福感和护理连续性。在 AT、DE、HR 和 HU 这四个国家，连续性也成为了专业人员、支付者和政策制定者的前三项。在这五个利益相关者群体中，专业人员的偏好与患者的偏好最常不同。在 AT、DE、ES、NL 和 NO，专业人员对身体机能的权重较低，而在 AT、DE、ES 和 HU，他们对以患者为中心的权重较高。支付者和政策制定者对成本的权重高于患者，但这些权重相对较低。
综合护理中，幸福感结果的生活享受是最重要的结果。这需要更多的社会和心理健康护理提供者的参与。患者和专业人员之间的意见分歧需要共同决策，在改善幸福感和以患者为中心的同时，不应忽视改善身体机能。
