Application of the JA-CHRODIS Integrated Multimorbidity Care Model (IMCM) to a Case Study of Diabetes and Mental Health

The SHAPES Smart Mirror Approach for Independent Living, Healthy and Active Ageing

The benefits that technology can provide in terms of health and support for independent living are in many cases not enough to break the barriers that prevent older adults from accepting and embracing technology. This work proposes a hardware and software platform based on a smart mirror, which is equipped with a set of digital solutions whose main focus is to overcome older adults’ reluctance to use technology at home and wearable devices on the move. The system has been developed in the context of two use cases: the support of independent living for older individuals with neurodegenerative diseases and the promotion of physical rehabilitation activities at home. Aspects such as reliability, usability, consumption of computational resources, performance and accuracy of the proposed platform and digital solutions have been evaluated in the initial stages of the pilots within the SHAPES project, an EU-funded innovation action. It can be concluded that the SHAPES smart mirror has the potential to contribute as a technological breakthrough to overcome the barriers that prevent older adults from engaging in the use of assistive technologies.

Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice

AIM

This scoping review is aimed at providing a current descriptive overview of care programs based on the chronic care model (CCM) according to E. H. Wagner. The evaluation is carried out within Europe and assesses the methodology and comparability of the studies.

METHODS

A systematic search in the databases PubMed, Embase, and MEDLINE via OVID was conducted. In the beginning, 2309 articles were found and 48 full texts were examined, 19 of which were incorporated. Included were CCM-based programs from Belgium, Cyprus, Germany, Italy, Switzerland, and the Netherlands. All 19 articles were presented descriptively whereof 11 articles were finally evaluated in a checklist by Rothe et al. (2020). In this paper, the studies were tabulated and evaluated conforming to the same criteria.

RESULTS

Due to the complexity of the CCM and the heterogeneity of the studies in terms of setting and implementation, a direct comparison proved difficult. Nevertheless, the review shows that CCM was successfully implemented in various care situations and also can be useful in single practices, which often dominate the primary care sector in many European health systems. The present review was able to provide a comprehensive overview of the current care situation of chronically ill patients with multimorbidities.

CONCLUSIONS

A unified nomenclature concerning the distinction between disease management programs and CCM-based programs should be aimed for. Similarly, homogeneous quality standards and a Europe-wide evaluation strategy would be necessary to identify best practice models and to provide better care for the steadily growing number of chronically multimorbid patients.

Comorbidity Patterns of Older Lung Cancer Patients in Northeast China: An Association Rules Analysis Based on Electronic Medical Records

Purposes: This study aims to identify the comorbidity patterns of older men with lung cancer in China. Methods: We analyzed the electronic medical records (EMRs) of lung cancer patients over age 65 in the Jilin Province of China. The data studied were obtained from 20 hospitals of Jilin Province in 2018. In total, 1510 patients were identified. We conducted a rank–frequency analysis and social network analysis to identify the predominant comorbidities and comorbidity networks. We applied the association rules to mine the comorbidity combination with the values of confidence and lift. A heatmap was utilized to visualize the rules. Results: Our analyses discovered that (1) there were 31 additional medical conditions in older patients with lung cancer. The most frequent comorbidities were pneumonia, cerebral infarction, and hypertension. (2) The network-based analysis revealed seven subnetworks. (3) The association rules analysis provided 41 interesting rules. The results revealed that hypertension, ischemic cardiomyopathy, and pneumonia are the most frequent comorbid combinations. Heart failure may not have a strong implicating role in these comorbidity patterns. Cerebral infarction was rarely combined with other diseases. In addition, glycoprotein metabolism disorder comorbid with hyponatremia or hypokalemia increased the risk of anemia by more than eight times in older lung cancer patients. Conclusions: This study provides evidence on the comorbidity patterns of older men with lung cancer in China. Understanding the comorbidity patterns of older patients with lung cancer can assist clinicians in their diagnoses and contribute to developing healthcare policies, as well as allocating resources.

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention (p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.

Lessons from the Implementation of Pilot Practices to Tackle the Burden of Noncommunicable Diseases in Europe

(1) Background: The gap between research findings and their application in routine practice implies that patients and populations are not benefiting from the investment in scientific research. The objective of this work is to describe the process and main lessons obtained from the pilot practices and recommendation that have been implemented by CHRODIS-PLUS partner organizations; (2) Methods: CHRODIS-PLUS is a Joint Action funded by the European Union Health Programme that continues the work of Joint Action CHRODIS-JA. CHRODIS-PLUS has developed an Implementation Strategy that is being tested to implement innovative practices and recommendations in four main areas of action: health promotion and disease prevention, multimorbidity, fostering quality of care of patients with chronic diseases, and employment and chronic conditions; (3) Results: The Three-Stages CHRODIS-PLUS Implementation Strategy, based on a Local Implementation Working Group, has demonstrated that it can be applied for interventions and in situations and contexts of great diversity, reflecting both its validity and generalizability; (4) Conclusions: Implementation has to recognize the social dynamics associated with implementation, ensuring sympathy toward the culture and values that underpin these processes, which is a key differentiation from more linear improvement approaches.