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

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.