Abstract
During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a priority in the health care plan. Interventions strategies and their implementation are still an emerging topic. In this context, Centro de Innovación en Salud ANCORA UC, together with Servicio de Salud Metropolitano Sur Oriente, implemented as a pilot study High-Risk Multimorbidity Integrated Care strategy. This study aimed to evaluate the impact of this strategy in terms of health services utilization and mortality. A cohort study was conducted with high-risk patients with multimorbidity, stratified by ACG®, intervened between April 2017 and December 2019. The studied population was 3,933 patients who belonged to similar size and location primary care centers. The impact analysis was performed used generalized linear models. Results showed that intervened patients had a significantly lower incidence in mortality (OR 0.56; 95% CI 0.40–0.77), hospital admissions, length of stay, and the number of hospital emergency consultancies. With the proper barriers and facilitators of a real context intervention, the implementation process allowed the systematization and consolidation of the intervention provided in this study. The training for new roles and the constant implementation support from the Centro de Innovación en Salud ANCORA UC team were essential in the progress and success of the intervention. A complete description of the high-risk intervention strategy is provided to contribute to this emerging topic and facilitate its scale-up. We can conclude that this complex intervention was feasible to be implemented in a real context. The Ministry of Health has taken the systematization and consolidation of the conditions for the national scale-up.
Highlights
Health systems have been challenged for the last years by the epidemic of noncommunicable diseases (NCDs), delivering in death of 41 million people each year, equivalent to 71% of all deaths globally [1]
In terms of the outcomes, we found that patients enrolled in the High-risk multimorbidity integrated care strategy had a statistically lower chance of dying during the follow-up than those who received the standard management
This strategy was associated with fewer hospital admissions, a shorter stay in the hospital, and a smaller number of consultancies to hospital emergencies (Table 3)
Summary
Health systems have been challenged for the last years by the epidemic of noncommunicable diseases (NCDs), delivering in death of 41 million people each year, equivalent to 71% of all deaths globally [1]. The COVID-19 pandemic has changed care priorities, abruptly disrupting chronic care, probably deepening this problem [4] To face this challenge in an effective way, care delivery needs to make the transition from the standard disease approach to patient-centered care with a strong emphasis on person multimorbidity and risk stratification [5, 6]. The risk stratification of the Kaiser Permanente Model that segments the chronic population for a more effective care delivery organization This approach could potentially prevent complications of underlying diseases, reducing the use of health services and personal health costs, keeping sick people under control [8, 9]
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