This thesis of Liann Weil explored the complexities of hospital care organization for patients with multiple long term conditions (MLTC) and identified opportunities to better identify patients who benefit most from adequately targeted integrated, collaborative care. The increasing prevalence of patients with MLTC challenges hospital care organization. Hospital care is currently organized around individual conditions, leading to fragmentation of healthcare. Integrated, collaborative care has been recommended to decrease over- or undertreatment and high healthcare utilization. Nonetheless, best practice guidance on effective integrated, collaborative care is missing.
Qualitative insights from a literature review and a Delphi exercise with healthcare professionals illustrated that multiple barriers, including time constraints and inadequate guidelines, challenge effective integrated care implementation. Patients that might benefit most from integrated and collaborative care were identified based on quantitative analyses of electronic health record data. Identified patients had a higher travel burden, high future healthcare utilization, and cardiometabolic and cardiopulmonary diseases. The findings illustrate that collaborative, integrated care approaches for patients with MLTC require context-specific adaptions and rewarding financial incentives. Data solidarity should be embraced, which enables data usage and sharing for healthcare to maximize benefits for patients and healthcare providers and minimize harm to individuals.
This thesis emphasizes that hospital care organization for patients with MLTC should be addressed as a wicked problem, i.e. a complex problem. Besides requiring appropriately targeted payment reforms that allow for uncertainties, are adaptive, and multidisciplinary, the wicked problem of the hospital care organization for patients with MLTC should be addressed with collaboration, coordination, and whole-system thinking.
