Health Care Models for Persons with Multiple Chronic Conditions from Populations that Experience Health Disparities: A Scoping Review.

Almost half of U.S. adults have multiple chronic conditions (MCC), and the prevalence of MCC has significantly increased for racial and/or ethnic minority groups, especially among those aged 45-64 years. Yet, little is known about evidence-based health care models for managing MCC in these populations. The overall objective of this scoping review was to identify the breadth of literature testing health care delivery models or components of models to improve the management of MCC for populations that experience health disparities. The databases of CINAHL Plus, Embase, PubMed, and Scopus were searched for original articles from 2016 to 2023. Included studies had to assess a health care delivery model, intervention, approach, or strategy for improving the management of two or more chronic conditions among U.S. adults. Using Covidence, each record was independently assessed by two reviewers and relevant data about the study, health care model, population studied, and outcomes were extracted. Out of 9583 initially screened records, 17 met the inclusion criteria, of which 5 (29%) were randomized controlled trials. Most (82%) studies focused on the management of psychiatric and physical chronic conditions. The most cited care model was the Patient-Centered Medical Home (41%). Most studies (82%) were conducted within clinical settings: primary care (n = 9), specialty care (n = 4), and behavioral health (n = 2). All studies documented positive improvements in patient outcomes, including fourteen (82%) studies that measured outcomes related to service utilization and eleven (65%) studies that measured clinical outcomes. Four studies (24%) measured cost-related outcomes. While the Chronic Care Model was developed almost 30 years ago, the applicable evidence for MCC is sparse for populations experiencing health disparities. There is an opportunity for research to develop, adapt, integrate, and implement evidence-based health care models for MCC to improve clinically significant health outcomes that align with the patient goal needs.