Co-management Model Research Articles

Expert consensus on multidisciplinary clinical management for chronic kidney disease

Chronic kidney disease (CKD) has been a major public health challenge threatening human health worldwide. When patients with CKD eventually progress to end-stage kidney disease, it imposes a substantial burden on individuals and society. Currently, the diagnosis rate of CKD in China remains low, with an unfavorable status regarding diagnosis and treatment. Therefore, it is urgent to establish a comprehensive prevention and treatment system of CKD, that enhances the multidisciplinary clinical management pathway for CKD patients while improving physicians' co-screening and co-management capabilities across various disciplines for high-risk individuals. Based on current evidence and clinical experience, we formulate the expert consensus on multidisciplinary clinical management approach for CKD, which aims to achieve early detection, early treatment, delay the progression of kidney failure, reduce the risk of cardiovascular, cerebrovascular diseases as well as death in CKD patients, while improving the prognosis of CKD patients and alleviating the burden of CKD disease with a multidisciplinary co-screening co-management model for CKD.

Global Gain, but Local Loss—National Park and Municipal Revenues in Poland

The paper analyzes the problem of stagnation in the creation of new national parks in Poland, identifying key barriers and proposing solutions. The background to the study refers to the role of national parks in nature conservation, but at the same time highlights the problem of the limited development of the park network in Poland, which remains at 1.05% of the country’s area—well below the EU average. The main obstacles identified by the author are the resistance of local governments due to the reduction in forest tax revenues and the differences in salaries between employees of national parks and state forests. Research methods included legal and economic analysis and a review of the literature on national park management. The results indicate that the problem can be solved by adequate financial compensation to local communities and the introduction of a co-management model that integrates the interests of local governments and parks. The article suggests that a change in the approach of the government administration and a more participatory management model can help to break the stagnation and increase the number of national parks, which is relevant not only for Poland but also for other countries struggling with similar challenges.

Innovative approaches to promote inclusive processes for noise barriers landscape integration

Noise barriers, in addition to their own functions as specific mitigation interventions to protect health, can represent important architectural elements, both in urban environment and natural context. In this perspective the design stage cannot ignore an integrated evaluation of the reference social and natural context based on the peculiarities and vocations of the territories involved. Aiming to the primary objective of identifying the "right" project that best fits into the reference territorial context, also for acoustic barriers it is therefore necessary to carry out a preliminary analysis of the socio-territorial and landscape context to understand specific local features of the territories and promote barriers as an essential part of the urban environment and landscape in a synergistic vision between innovation and sustainability also through new models of co-design and co-management with the communities involved. This paper aims to describe the approach adopted by RFI - the National Manager of the Italian Railway Network - to promote effective integration and synergy between noise mitigation interventions and the territorial reference context with the aim of creating a "tailor-made" project with the contribution of citizens and stakeholders.

A potential model of national forest co-management: History of aspen management on the Leech Lake Reservation and Chippewa National Forest in Minnesota

Aspen exists as the most abundant and industrially important forest type in contemporary Minnesota. Historically, the species was seen as economically undesirable yet saw prolific increases in abundance due to pine harvest and fire. The Leech Lake Reservation exists as a unique case study of tribal-U.S. Forest Service co-management, with 90 % of reservation land within Chippewa National Forest boundaries. This large geographical intersection was created by a series of American Indian law policies and makes the relationship between the Chippewa National Forest and the Leech Lake Band of Ojibwe unique within the USDA National Forest System. Comparison of pre-reservation and more modern forest/land cover types within the modern-day boundaries of the Leech Lake Reservation were conducted alongside investigation of historical management authority documentation of Chippewa National Forest and Leech Lake Band of Ojibwe cooperation and broader historical management of aspen in Minnesota. Results suggest historical power dynamics between the Chippewa National Forest and Leech Lake Band of Ojibwe influenced decreasing pine and increasing aspen on the Leech Lake Reservation. However, the modern relationship between the Chippewa National Forest and the Leech Lake Band of Ojibwe shows the potential for successful co-management within the shared goals of aspen management.

Community-based natural resource management in Roatan: Strengths and challenges.

This study explored the transformative journey of community-based natural resource management (CBNRM) in the Bay Islands National Marine Park, Honduras, revealing the interplay of cooperation, funding, and communication in fostering successful conservation initiatives. Using a mixed-method approach, we investigated the historical and legislative process and enabling conditions that led to the transition to CBNRM, based on Gruber's 12 key principles. In regards to the present CBNRM system, we looked at its strengths, its challenges, and whether its functioning is seen as satisfying by local resource-users. Findings showed that key CBNRM principles-including an enabling environment, conflict resolution, research-based decision-making, public trust, and monitoring-fostered the transition. Furthermore, satisfaction with reef management and perceived patrol effectiveness, which are pivotal aspects in CBNRM, exceeded 70% in Roatan. Challenges such as strengthening local institutions and enhancing compliance were identified. Nonetheless, co-managers are actively working to resolve these challenges by focusing on enforcement, diverse funding acquisition mechanisms and community participation. The study underscores the pivotal role of local NGOs and collaborative committees in facilitating successful CBNRM. By providing evidence-based insights, we highlight the efficacy of multilevel, co-management models in resource management and emphasize the value of adaptable strategies. These findings contribute to a deeper understanding of CBNRM dynamics in Latin America and the Caribbean, which may ultimately foster successful conservation initiatives in the Global South.

Motivation-based visitor segmentation in the context of a new governance model for a protected area

ABSTRACT Understanding visitor motivations is crucial for developing sustainable tourism strategies in protected areas (PAs). However, the literature often overlooks the role of visitor motivation research in enhancing place-based collaborative governance within PAs. This study focuses on the Alvão Natural Park (PNAL), a mountainous Portuguese PA currently implementing a new co-management model. This represents a significant change, considering that the governance of the PA has shifted from a single state entity to a collaborative model that prioritises tourism as a key factor in local development. This study seeks to address the research gap regarding motivation-based segmentation studies in mountainous natural parks, while exploring the innovative aspects of conducting such a study within the framework of a new governance model. By surveying 351 PNAL visitors, factor analysis revealed four motivational dimensions with emphasis on connection with nature and relaxation. However, cluster analysis identified only one segment primarily motivated by connecting with nature, while the largest segment is motivated by convenience and social environment interactions. The results suggest the importance of involving the local community in governance and decision-making processes, and the need to prioritise ecotourism as a key focal point in PNAL's tourism policies, strategic planning, and development. Our findings contribute to theoretical knowledge and inform policy-making, providing valuable guidance for the successful implementation of co-management in PNAL and potentially other similar PAs.

Environmental impacts in water resources surrounding world surfing reserves: A case study in the Madre Watershed, Brazil

In order to promote the adoption of an ecosystem-based approach in environmental management processes, integrated assessment studies can be conducted to link human activities and observed impacts on natural environments. Analytical models such as DPSIR are used, based on the monitoring of environmental indicators, to improve planning and management processes for water resources at multiple scales. World Surfing Reserves (WSRs) are institutions that have been utilizing this environmental assessment model to successfully implement environmental management strategies and instruments in coastal zones. Building upon the adaptive co-management model developed in the 6th WSR of Bahía de Todos Santos (Mexico), which incorporates DPSIR analysis and the use of GIS (remote sensing) tools in environmental assessment, this research develops a protocol for integrated environmental assessment, focusing on water resource management, through a case study conducted in the 9th WSR of Guarda do Embaú, Santa Catarina, Brazil. It is understood that this protocol can be utilized in other surfing reserves, especially in estuarine regions, to identify priority aspects for water resource management through: (i) water quality indicators, (ii) institutional environmental monitoring reports, and (iii) georeferenced statistical data (GIS). Based on these data, integrated analyses were conducted to determine which polluting agents pose a greater risk to the sustainable management of water resources surrounding the 9th WSR. Among the observed results, it was found that multiple pressure factors pose high environmental risk to the water resource stocks, mainly due to the discharge of urban and agricultural effluents into rivers, as well as deforestation in protected areas directly associated with the conservation of water reservoirs. As a result of these factors, a moderate risk of eutrophication, water scarcity, unavailability of recreational water use, disease spread, and sedimentation was observed, alongside a high risk of biodiversity loss, habitat loss, and unavailability of drinking water. Due to the risks of the mentioned impacts, the aspects identified in this study require management at the appropriate scale for processes occurring in the watershed, in order to gradually mitigate the effects of polluting activities.

Co-management as an Ethical Space of Engagement: Prospects for Reconciliation in Vuntut National Park

Parks Canada’s commitments to reconciliation marks a significant shift in the governing paradigm of national parks, moving away from a colonial framework towards models that respect and elevate Indigenous forms of governance and knowledge systems. However, the extent to which a land claims–based co-management model, as the dominant mechanism of governance and engagement employed by Parks Canada, can serve as a vehicle for reconciliation is an open question. This paper endeavours to better understand the relational dynamics of co-management for their potential to advance reconciliation in national park settings. Using the lens of ethical space, we identify factors that either facilitate or impede relationship building between Vuntut Gwitchin First Nation and Parks Canada in the co-management of Vuntut National Park. Insights from semi-structured interviews conducted in 2021 with 11 community members and park managers indicate that an evolving-management relationship is sustained through extensive community engagement and Parks Canada’s support for strengthening community connections to the land. By adopting an ethical space framework for analysis, we were able to highlight different conditions and elements necessary for a protected-area co-management arrangement to serve as a solid foundation for reconciliation. Our analysis also revealed various structural impediments to the establishment of an ethical space conducive to reconciliation, particularly in the context of co-management arrangements based on land-claims agreements. These challenges included: discrepancies in approaches to protected-area management between Vuntut Gwitchin First Nation and Parks Canada, further complicated by the governance system employed by Parks Canada; issues of scale related to Parks Canada’s nested management structure, which affected relationship building between co-managers; financial constraints; and capacity constraints.

Clinical Outcomes of Orthopedic Surgery Co-Management by Internal Medicine Advanced Practice Clinicians: A Cohort Study

BackgroundComanagement of orthopedic surgery patients by internal medicine hospitalists is associated with improvements in clinical outcomes including complications, length of stay, and cost. Clinical outcomes of orthopedic comanagement performed solely by internal medicine advanced practice clinicians have not been reported. Our objecyive was to compare clinical outcomes between advanced practice clinician-based comanagement and usual orthopedic care. MethodsThis is a retrospective cohort study in patients 18 years or older, hospitalized for orthopedic joint or spine surgery between May 1, 2014 and January 1, 2022. Outcomes assessed were length of stay, intensive care unit (ICU) transfer, return to operating room, in-hospital and 30-day mortality, 30-day readmission, and total direct cost, excluding surgical implants. Generalized boosted regression and propensity score weighting was used to compare clinical outcomes and health care cost between usual care and advanced practice clinician comanagement. ResultsAdvanced practice clinician comanagement was associated with a 5% reduction in mean length of stay (rate ratio = 0.95, P = .009), decreased odds of returning to the operating room (odds ratio [OR] 0.51, P = .002), and a significant reduction in 30-day mortality (OR 0.32, P = .037) compared with usual orthopedic care in a weighted analysis. Need for ICU transfer was higher with advanced practice clinician comanagement (OR 1.54, P = .009), without significant differences in 30-day readmission or in-hospital mortality. ConclusionsWe observed reductions in length of stay, health care costs, return to the operating room, and 30-day mortality with advanced practice clinician comanagement compared with usual orthopedic care. Our findings suggest that advanced practice clinician-based comanagement may represent a safe and cost-effective model for orthopedic comanagement.

Outcomes of Children Admitted to a Pediatric Observation Unit With a Psychiatric Comanagement Model

This cohort study describes outcomes of children requiring admission for mental health emergencies who receive psychiatric cotreatment in a pediatric observation unit.

Risk and complication profiles of orthogeriatric patients in elective hip and knee joint replacement

The care of geriatric patients undergoing elective orthopedic surgery is becoming increasingly more important due to demographic trends. Compared to geriatric traumatology, however, there are still no established orthogeriatric care models in Germany and therefore hardly any scientific data. The aim of this study was to describe the risk and complication profiles in older patients with elective hip and knee replacements. In aprospective study data were collected from orthogeriatric patients with indications for elective hip and knee replacement surgery who fulfilled defined inclusion and exclusion criteria between January 2021 and August 2023 in the orthopedic department of aGerman university hospital for the descriptive analysis of risk and complication profiles. In addition to apreoperative and perioperative data analysis, afollow-up was conducted 4-6weeks and 3months postoperatively. The surgical risk profile of the patient population analyzed was characterized by advanced age (78.4 ± 4.8years), preobesity/obesity (76%), multimorbidity (7.4 ± 3.1 comorbidities), polypharmacy (7.5 ± 3.8 medications), immobility (short physical performance battery 7.1 ± 2.6), prefrailty/frailty (87%), frequent anticoagulation (22%) and ahigh number of potentially inappropriate medications (64%). Complication events mainly occurred within the first 7days postoperatively and 90% of the events within this recording period were minor complications. The overall complication rate significantly decreased in the follow-up period. Due to the high risk and complication profiles the routine use of orthogeriatric co-management models for elective orthopedic surgery should be considered in the future.

Asking the generalist – evaluation of a General Practice rounding and consult service

BackgroundVascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications.MethodsThe GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz’ qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional “as needed” GP-consult service.Results15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes.ConclusionsA GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults.Trial registrationNot applicable.

The bumpy road to conservation: Challenges and opportunities in updating the Galapagos zoning system

In 2014, the Galapagos National Park Directorate, sponsored by various international non-governmental organizations, initiated a comprehensive marine and terrestrial spatial planning process to improve the management effectiveness of Galapagos’ protected areas. This effort aimed to reconfigure management areas by expanding or redistributing no-take zones to protect Key Biodiversity Areas and ensure the conservation of at least 30% of terrestrial and marine ecosystems in the Galapagos. However, this process encountered significant challenges, notably the erosion of fishers' trust following the implementation of a "Marine Sanctuary". This top-down decision resulted in socio-political tension, compelling the Ecuadorian government to delay the implementation of the new marine zoning until there was conclusive scientific data on its socio-economic impact on local small-scale fishers’ livelihoods. This paper examines the achievements and shortcomings of the Galapagos zoning update process, highlighting the successful integration of scientific zoning criteria and the enhanced protection of critical biodiversity areas, together with the reduced support from fishers and legal disputes. To move forward, we recommended a bottom-up approach centered on rebuilding trust among the fishing community via innovative engagement strategies and the introduction of market incentives to promote sustainable practices. Assessing the long-term impact of no-take zones is essential for refining management approaches. Additionally, the application of cutting-edge technology within an adaptive co-management model is recommended to improve fisheries and ecological data gathering and analysis, facilitating proactive and well-informed management decisions. Our suggestions aim to reconcile conservation objectives with the needs and aspirations of the local communities in this iconic archipelago.

The value proposition for geriatrics.

In response to some of the challenges that have been articlulated about the future of Geriatrics, we describe a more positive view and value proposition for the field. Health professionals with specific training in Geriatrics are a natural fit for a variety of roles in value-based care (VBC) programs and health systems. These roles include serving as educators for primary care health professionals and specialists in person-centered care of older adults, serving as consultants on geriatric conditions and syndromes in a co-management model of care, becoming effective leaders in VBC programs and health systems, and conducting quality improvement initiatives to build on the evidence-base for the management of common conditions in the older population. We further recommend that VBC programs and systems support Centers of Excellence or Institutes to implement these strategies within and Age-Friendly, learning system approach.

Cooperation of geriatrics and trauma surgery in certified geriatric trauma centers : Insights into different care models and the implementation of requirements resulting from certification

In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery and geriatrics and if the quality of care had changed since the certification of the centers. In this study 4 guided focus group interviews (FGI) were conducted in different teams of certified geriatric trauma centers in 3 federal states with 16participants. To specify the content of the FGI, two additional interviews were conducted with system auditors. Both types of interview were analyzed by content analysis. The certification supported the implementation of structures and processes in the different orthogeriatric models; however, the quality of care and cooperation between surgery and geriatrics depends on the spatial proximity and the orthogeriatric care model in the geriatric trauma centers. Simultaneously, challenges in the area of geriatric syndromes and the recruitment of skilled staff became relevant. The results can help to reflect processes in the certified geriatric trauma centers and to treat geriatric syndromes more effectively. In the future, the challenge will be to establish geriatric care under the existing shortage of skilled staff.

GERIATRICS TRAUMA CO-MANAGEMENT: PRELIMINARY DESCRIPTIVE DATA FROM A SINGLE ACADEMIC INSTITUTION

Abstract Background Traumatic injuries cause higher mortality and complications in older patients than in younger individuals. Orthogeriatric co-management programs improve outcomes and quality of care and may be a model for trauma management. We theorized that geriatricians could improve trauma care in older adults with the early identification of geriatric syndromes. Methods A retrospective chart review was conducted for patients aged > 65 years admitted to the trauma surgery service at a Level 2 trauma center between October 2022 and January 2023, who were co-managed by geriatricians as part of a pilot program. Results 67 patients were included in this study. The mean age was 81 (65-99), and 38% were male. The most common injuries were rib fractures (39%), subdural hematomas (32%), and spinal fractures (10%). Geriatric syndromes identified and managed by a geriatrician included frailty (47%), major or minor cognitive impairment (48%), delirium (19%), malnutrition (13%), and polypharmacy (65%), with a mean number of 6.7 home medications. As per Beers criteria, 63% of patients were taking inappropriate medications. Geriatrician-led interventions in advance care planning included identification and documentation of healthcare proxies (i.e., increased to 87% from 11% on admission) and goals of care conversations (54%). Conclusions Given the high prevalence of geriatric syndromes and complex medical and social needs in older patients with trauma, geriatric co-management may enable timely diagnosis and treatment of conditions that cause poor outcomes. Further research is warranted to assess the impact of geriatric co-management models on the long-term clinical outcomes in older individuals after injury.

Symposium 10: Spotting EGPA from Asthma Populations and How Co-Care Works Between Rheumatology and Respiratory Physicians: A Case Sharing

Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare systemic vasculitis characterized by asthma, eosinophilia, and vasculitic organ involvement. This rare disease poses diagnostic challenges within the domain of severe asthma. Recognizing EGPA within the asthmatic cohort is therefore crucial for appropriate management and improved patient outcomes. Moreover, effective collaboration between rheumatologists and respiratory physicians is vital for the comprehensive care of EGPA patients. This scientific lecture aims to discuss the identification of EGPA in individuals with asthma and highlight the importance of co-care between rheumatology and respiratory medicine. This lecture will begin by providing an overview of EGPA, its clinical manifestations, and the challenges associated with differentiating it from severe asthma. The crucial identification of distinctive clinical features, such as refractory asthma, peripheral eosinophilia, and systemic symptoms, which serve as beacons for the presence of EGPA, will be discussed. Diagnostic tools encompassing imaging, laboratory tests, and biopsy techniques are explored, focusing on their utility in distinguishing EGPA from asthma. Concomitantly, the lecture will then shift its focus to the collaborative efforts required from rheumatologists and respiratory physicians in managing EGPA patients. The complementary roles of both specialties in achieving optimal patient outcomes will be discussed. Rheumatologists play a crucial role in the diagnosis and treatment of systemic vasculitis, including EGPA, while respiratory physicians provide expertise in managing asthma and respiratory complications. The case will highlight the importance of open communication, shared decision-making, and coordinated treatment plans to ensure comprehensive care for EGPA patients, addressing both their rheumatologic and respiratory needs. Real-life case will be shared to illustrate successful co-management models between rheumatology and respiratory medicine. These examples will underscore the benefits of a multidisciplinary approach, including improved disease management, reduced treatment-related complications, and enhanced patient satisfaction. In conclusion, identifying EGPA within the asthma population is crucial for appropriate management, and effective collaboration between rheumatology and respiratory physicians is essential for comprehensive care. This scientific lecture aims to provide insights into spotting EGPA among asthma patients and emphasize the significance of co-care between these specialties, ultimately improving patient outcomes and quality of life.

Towards Sustainable Tourism Development in a Small Protected Area: Mapping Stakeholders’ Perceptions in the Alvão Natural Park, Portugal

ABSTRACT The Alvão Natural Park (PNAL) is the smallest natural park in Portugal. The PNAL is currently in the process of implementing its co-management model, abandoning the old centralized top-down model, and aiming for a more sustainable development of the protected area. Recognizing the key role of stakeholders in sustainable tourism development in protected areas, this study examines how PNAL stakeholders perceive various topics related to sustainable tourism and local development. To this end, 19 PNAL stakeholders participated in two focus groups that were conducted to collect the primary data. NVivo software was used for content analysis and mapping stakeholders’ perceptions. The results indicate that even though the stakeholders believe that the protected area has great tourism potential and that the park’s residents are open to tourism, public authority conflicts and the lack of infrastructure and services to support tourism present obstacles to a sustainable tourism development.

Conservation and Co-Management of Rock Art in National Parks: An Australian Case Study

Using rock art conservation as a focus, this paper outlines the levels of legislated protection afforded to designated natural and cultural areas/sites in Australia and describes the co-management approach adopted in 1998 in relation to Mutawintji National Park in western New South Wales. The park encompasses four different protection categories: a Historic Site, a Nature Reserve, a National Park, and a State Conservation Area. Known for more than a century, the Historic Site is a major area of rock art containing Aboriginal engravings, paintings and stencils. Management of the Historic Site is a key concern, given the tourist interest and associated potential for accelerated deterioration of cultural heritage. The Mutawintji Plan of Management pointed to the importance of Mutawintji for Aboriginal people to connect with the country, and the co-management model encouraged tourism development as a means of providing employment opportunities as Aboriginal guides. No special legislative requirements in relation to rock art conservation, beyond those already in existence, were applied to the co-management system. Using field knowledge involving rock art research and early guide training programs at Mutawintji and literature sources, this paper suggests possible future approaches to rock art conservation in the Mutawintji Lands.

Development of a conceptual framework to scale up co-managed care for older patients with hip fracture in China: a qualitative study

BackgroundHip fracture creates a major burden on society due to high mortality, loss of independence and excess medical costs for older people. A multidisciplinary co-managed model of care is widely considered as the best practice for the management of older patients with hip fracture. The study aims to develop a conceptual framework to inform the future scale-up of this model of care through the identification of barriers and enablers that may influence successful uptake.MethodsThis qualitative study was conducted within an interventional study, which aimed to test the effectiveness of co-managed model of care for older patients with hip fracture. Health providers and health administrators from three hospitals were purposively selected and interviewed in-depth. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview guides, collect and analyse data. Inductive and deductive approaches were used to generate enablers or barriers, aligned with the CFIR constructs. All barriers or enablers were inductively summarised to a conceptual framework with essential components to guide the implementation of co-managed model of care in other hospitals.ResultsA total of 13 health providers and 3 health administrators were recruited. The main barriers to co-managed care implementation included perceived complexity of implementation, insufficient international collaboration and incentives, the absence of national guideline support and lack of digital health applications for communication between health providers, insufficient number of health providers and beds, and poor understanding about the effectiveness of this care model. A conceptual framework for future scale-up was then developed, consisting of the following essential components: hospital authority support, enabling environment, adequate number of beds, sufficient and skilled health providers, use of digital health technology, regular quality supervision, evaluation and feedback, and external collaborations.ConclusionsDespite the complexity of the intervention, the co-managed model of care has the potential to be implemented and promoted in China and in similar settings, although there is a need to demonstrate feasibility in different settings.