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Integrated care for people with multimorbidity into elective surgical pathways: mixed-methods co-design study.

Sivesh K Kamarajah1,2, Jugdeep Dhesi3,4, Kamlesh Khunti5

  • 1Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.

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Summary

Co-designing a new model for multiple long-term conditions (MLTC) care in elective surgery pathways improves patient health. This intervention integrates MLTC management earlier in the surgical process.

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Area of Science:

  • Health Services Research
  • Complex Interventions
  • Patient Care Models

Background:

  • Elective surgery pathways are ill-equipped for patients with multiple long-term conditions (MLTC).
  • Current systems offer limited opportunities to optimize patient health before surgery.
  • A co-designed intervention is needed to integrate MLTC care into surgical pathways.

Purpose of the Study:

  • To co-design a feasible intervention integrating multiple long-term conditions (MLTC) care into elective surgical pathways.
  • To address the complex needs of patients undergoing elective surgery.

Main Methods:

  • A theory-informed, mixed-methods co-design study.
  • Phase 1: Contextual analysis of UK surgical pathways (mapping, policy scan, national survey).
  • Phase 2: Multidisciplinary stakeholder workshops to develop a Theory of Change.

Main Results:

  • Pathway mapping revealed variations and delayed pre-assessment, limiting chronic disease optimization.
  • No UK guidance was found for integrating MLTC into surgical pathways; few hospitals had specific pathways.
  • A pragmatic intervention was co-designed, focusing on diabetes, hypertension, weight management, and smoking cessation, with five key components.

Conclusions:

  • A co-designed model shifts multiple long-term conditions (MLTC) care upstream to the point of surgical listing.
  • This approach has the potential to enhance both short-term and long-term patient health outcomes.