Abstract

Objective: The Horizon2020 project SELFIE aims to contribute to the evidence on integrated care in multi-morbidity by applying Multi-Criteria Decision Analysis (MCDA). The first step in the MCDA was the selection and description of 17 integrated care programmes for multi-morbidity and understanding the decisions that need to be informed by the MCDA.

Methods: In the beginning of the SELFIE project a conceptual framework for integrated care in multi-morbidity was developed. It puts the individuals with multi-morbidity and their environment and resources in the centre that is surrounded by the micro, meso, and macro layers of six components: (1) service delivery, (2) leadership and governance, (3) workforce, (4) financing, (5) technologies and medical products, and (6) information and research. This framework is used to structure the in-depth ‘thick’ descriptions of the 17 programmes. In the thick descriptions, a formal description of the ‘hard facts’ in each component is given, as well as a description that goes one layer deeper and addresses the ‘soft facts’ that lie beneath the surface. A comparative qualitative analysis of the 17 thick descriptions was made to highlight similarities and differences between the programmes, in particular with respect to implicit aspects that are crucial to the functioning of the programmes.

Results: Seventeen promising integrated care programmes for multi-morbidity were selected and grouped into four categories: (1) population health management programmes (n=6), (2) frail elderly programmes (n=5), (3) programmes for individuals at the end-of-life and oncology patients (n=3), and (4) programmes for vulnerable individuals who face problems in multiple life domains, like health, housing, and financial problems (n=3). Aspects that emerged as central to the functioning of the programmes were the assessment of the multi-morbid individuals’ needs, a holistic approach to care, continuity of care, involvement of the client in all steps of the care process, aspects of informal caregiver involvement, self-management initiatives as well as relationships between the involved professionals.

Discussion: Based on a qualitative analysis of 17 integrated care programmes for multi-morbidity, several common barriers and facilitators for the functioning of these programmes were identified. In particular, aspects of personal relationships as well as person-centeredness emerged as crucial for the success of the programmes. These identified aspects and experiences can be valuable for the future implementation of new programmes for multi-morbidity.