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A Multidisciplinary Integrated Care Program for Complex Chronic Patients: A Real-World Evaluation of Healthcare
Jorge Martins1, António Oliveira1, Inês Chora1,2
1Internal Medicine Department, ULS Matosinhos, Senhora da Hora, 4464-513 Matosinhos, Portugal.
Abstract:
Background: Complex chronic patients (CCPs) frequently experience fragmented care and high healthcare utilization. Integrated multidisciplinary care may improve care coordination and reduce reliance on acute healthcare services, although evidence regarding its impact on healthcare utilization and costs remains inconsistent. This study evaluated the real-world impact of a multidisciplinary integrated care program on healthcare utilization and provider costs among CCPs. Methods: This retrospective before-and-after study included CCPs enrolled in a multidisciplinary integrated care program between 2016 and 2023. Healthcare utilization and provider costs from the provider perspective were compared for up to two years before and after enrollment. Results: The study included 473 patients with a median age of 82 years, 56.7% of whom were women. Significant reductions in acute and ambulatory healthcare utilization and overall provider costs were observed following enrollment and were sustained over two years (p < 0.001). Exploratory economic analyses showed that lower provider costs occurred alongside reductions in acute healthcare utilization. Conclusions: A multidisciplinary integrated care program for CCPs was associated with sustained reductions in healthcare utilization and provider costs over two years. These findings support the potential value of integrated multidisciplinary care for CCPs.
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