Sapag Jaime C, Pérez Mayra Alicia Martínez, Zamorano Paula, Varela Teresita, Muñoz Paulina, Seguel Romina, Irazoqui Esteban, Téllez Álvaro
School of Public Health & School of Medicine, Department of Family Medicine), Faculty of Medicine, Pontificia Universidad Católica de Chile, 11 Santiago, Chile.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Arch Public Health. 2025 May 9;83(1):127. doi: 10.1186/s13690-025-01516-4.
The impact of non-communicable diseases and multimorbidity challenges health systems worldwide. Latin America faces an urgent need to develop practical innovations in that regard. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model (MPCM) pilot in Chile between 2017 and 2020. MPCM aimed to reorganize health services from a fragmented diagnosis-based perspective towards a new approach based on patient's needs and offer intervention strategies according to their multimorbidity risk. This article aims to report the evaluation of the implementation process of MPCM in the Southeast Metropolitan Health District in Chile.
The study design corresponds to an implementation collaborative evaluation of MPCM innovation using qualitative methodology. Two main questions guided the research: (1) How has MPCM been implemented in its pilot phase? Moreover, (2) What are the main learnings from the MPCM pilot phase and their contribution to its scalability at the national level? In addition, the Consolidated Framework for Implementation Research and the Outcomes for Implementation Research were considered in the theoretical approach.
Thirty-five (35) interviews were conducted with 69 professionals and key stakeholders involved in the implementation process of MPCM, including health practitioners, transition nurses who coordinate the intervention with the affiliated hospitals, managers, and the implementation team. Overall, the results were positive, suggesting that a complex innovation of this kind may be implemented successfully. Key lessons learned should be considered for scaling up MPCM to the national level. Some critical barriers to implementation were high staff turnover and the COVID-19 pandemic, while leadership and team commitment were relevant facilitators.
This study represents a new step in evaluating an innovative model for addressing multimorbidity in Chile. The scaling up phase requires careful consideration of all lessons learned, as well as a robust evaluation and monitoring plan. This research represents the first evaluative analysis of MPCM in the context of a complex innovation adapted to enhance public health policies using implementation evaluation approaches. Implementation Science is a fundamental approach to fostering quality improvement strategies for health care in Latin America.
非传染性疾病和多重疾病的影响给全球卫生系统带来了挑战。拉丁美洲迫切需要在这方面开展切实可行的创新。2017年至2020年期间，智利天主教大学健康创新中心ANCORA在智利实施了一项新的以患者为中心的多重疾病护理模式（MPCM）试点项目。MPCM旨在将卫生服务从基于碎片化诊断的视角重新组织为基于患者需求的新方法，并根据患者的多重疾病风险提供干预策略。本文旨在报告对智利东南部大都会卫生区MPCM实施过程的评估。
该研究设计对应于使用定性方法对MPCM创新进行的实施协作评估。两个主要问题指导了这项研究：（1）MPCM在其试点阶段是如何实施的？此外，（2）MPCM试点阶段的主要经验教训是什么，以及它们对其在国家层面的可扩展性有何贡献？此外，在理论方法中考虑了实施研究综合框架和实施研究成果。
对参与MPCM实施过程的69名专业人员和关键利益相关者进行了35次访谈，包括卫生从业人员、与附属医院协调干预措施的过渡护士、管理人员和实施团队。总体而言，结果是积极的，表明这种复杂的创新可能会成功实施。在将MPCM扩大到国家层面时，应考虑关键经验教训。实施过程中的一些关键障碍是员工流动率高和新冠疫情，而领导力和团队承诺是相关的促进因素。
本研究是评估智利应对多重疾病创新模式的新一步。扩大阶段需要仔细考虑所有经验教训，以及强有力的评估和监测计划。本研究是在采用实施评估方法以加强公共卫生政策的复杂创新背景下对MPCM进行的首次评估分析。实施科学是促进拉丁美洲医疗保健质量改进策略的基本方法。
