Abstract
Introduction: Multimorbidity is a growing concern across global healthcare, and is associated with poor quality of life and high utilization of healthcare resources. Multimorbidity exists on a spectrum of complexity with some patients experiencing high quality of life and low disease burden, while other patients experience very poor quality of life and high treatment burden. In addition, complex patients often experience fragmentation of care and higher rates of care transitions, leading to suboptimal treatment. While complex cases may present at earlier age groups, it is most prevalent among elderly patients. It is imperative to develop and utilize integrated care assessment tools to stratify patients based on their care complexity, in order to provide patient-centered care to those with highest need.
Aim: This scoping review aims to identify assessment tools developed and/or utilized in an integrated care context for elderly patients with multimorbidity.
Methods: A protocol was submitted for publication prior to this study. A search strategy was developed and piloted between all authors, and was further refined through discussion between researchers and clinicians. Embase, MEDLINE, The Cochrane Library, PsycINFO and CINAHL was searched for studies from January 2007 to May 2023. Two authors (JC, MM) independently screened articles on title-abstract and full-text reviewing using Covidence (www.covidence.com). Consensus was mediated through two senior researchers (DH, LB). Data extraction format was developed in collaboration with all authors. Data on study, population and outcome characteristics was extracted for synthesis by two authors (JC, MM).
Results: 3 studies were included in the final synthesis. Studies were composed of assessment tools developed through cross-sectoral collaboration (n = 1), a case study using assessment tool to provide integrated care (n=1), and a RCT using assessment tools to assess risk of hospital readmission (n=1). All studies included elderly patients above 65 years with multimorbidity (total diseases: 5-11). A single study stratified patients as complex versus non-complex.
Conclusion: Stratification tools that is developed through, or used in an integrated care context, in order to identify elderly patients with multimorbidity, is lacking. Future research should focus on developing assessment tools of patients’ care complexity using biopsychosocial determinants in order to identify and provide integrated care interventions to this patient population. These tools should be developed in collaboration among researchers, clinicians and allied healthcare workers, and should be validated across sectors.
Future work and practical impact: The review has informed the development of a stratification tools – developed in collaboration with clinicians, municipalities, researchers, general practitioners, and patients – to stratify patients as patients with complex or non-complex multimorbidity. It will be utilized for selection of complex patients at hospitals to an integrated video-based care plan developed between hospitals, municipalities, primary care physicians and the patient and relatives.