Parallel to an ageing society is the increase in prevalence of multi-morbidity. Persons with multi-morbidity often deal with multiple care providers in both the health- and social care sectors, and are likely to benefit from person-centred integrated, and well-coordinated, care. Different integrated care programmes for multi-morbidity can be identified, however, further developments in the field are needed. The Horizon2020 EU project ‘SELFIE’ (Sustainable intEgrated care modeLs for multi-morbidity: delivery, FinancIng and pErformance) aims to address these needs. In the coming years, we would like to update readers of the IFIC-blog on the progress we make in SELFIE.
The SELFIE project has three main strands of research on integrated care for individuals with multi-morbidity: 1) cross-country descriptive comparison, 2) intra-country empirical evaluations of promising integrated care programmes for multi-morbidity and payment schemes, 3) and synthesis, implementation, and transferability. These three main strands are divided into seven work packages, which are being carried out by a research consortium from eight countries across Europe (The Netherlands (coordinator), Austria, Croatia, Germany, Hungary, Norway, Spain, and the UK). As we reached our one-year mark in September of 2016, we’d like to sum up some things we’ve already achieved and look ahead at what’s to come.
The SELFIE project began with the development of a ‘conceptual framework’. This framework allowed us to describe promising integrated care programmes in a uniform manner. To create this framework, we performed an extensive scoping review of the scientific and grey literature in the field of integrated care, specifically for multi-morbidity. However, we believe that using ‘just’ literature is not sufficient. We wanted to include stakeholders in the development of the framework. Therefore, we included our SELFIE international and national stakeholder advisory boards in the process. These boards consist of representatives from the ‘5P’ stakeholder groups: Patients, Partners (i.e., informal caregivers), Professionals, Payers (e.g., health insurers), and Policy makers. Throughout the SELFIE project, we will ask these stakeholders to reflect on our work and findings. Scientific publications on the development and description of the framework are underway. For now, feel free to take a look at the image of the framework!
Our next step was to select promising integrated care programmes with whom we would collaborate further in SELFIE. Through the scoping review, (inter)national stakeholder advisory board meetings, and informal talks with our networks, a long-list of promising integrated care programmes in each partner country was made and eventually a selection of 17 programmes was made (two or three per country). These range from small-scale case finding strategies, screening programmes, regional approaches, to population health management. The focus of the programmes also varies from being prevention-oriented, crossing health- and social care boundaries, palliative care, and transfer care. Furthermore, the multi-morbidity target group is quite broad, including frail elderly, persons with purely medical co-morbidities, and persons with multi-problems in various life domains. Interested in which programmes we’ll be working with the coming years? See the executive summary of the first deliverable report!
In order to learn as much as possible about the selected programmes we conducted document analyses and interviews with relevant stakeholders from each programme. We bundled and analysed our findings into ‘Thick Description’ reports that can allow for comparisons to be made across contexts and for countries to learn from one-another. These thick descriptions are structured according to the SELFIE conceptual framework. We’ve recently finished these reports and we will be making them publicly available before 2017. Currently, we’re working on the cross-programme and cross-country comparisons.
The second, and largest, strand of research in SELFIE is to empirically evaluate these 17 promising programmes. Each partner is currently discussing with the selected programmes how an extensive evaluation, using Multi-Criteria Decision Analyses (MCDA) can be set up. To support this process, we’ve been making an inventory of outcomes that may be included in such an evaluation. In order to develop a complete, and truly person-centred, list of outcomes, each partner country has organised focus groups with persons with multi-morbidity to ask them: ‘what matters to you when it comes to health and care processes?’ These focus groups led to a ‘core set’ of outcomes that could be included in the evaluation of integrated care programmes for multi-morbidity. The next step in the MCDA-process is to elicit weights for these outcomes. Therefore, all 5P stakeholders will be approached to fill in a discrete choice experiment (DCE).
We can look back at a productive first SELFIE-year, and look ahead at what’s to come… In the coming months we’ll focus on creating an MCDA evaluation design that satisfies all stakeholders and we’ll be setting out the DCE in all eight countries.
We hope that you enjoyed this blog and will check out our future blogs in which our international SELFIE colleagues will also share their experiences!
Check out the SELFIE website for more information and to see regular project updates.
Version: November, 2016
Meet the SELFIE consortium:
The Netherlands (coordinator)
Institute of Health Policy & Management, Erasmus University Rotterdam
Department of Health Care Management, Technical University of Berlin
Department of Economics, University of Bergen
Department of Economics and Finance, Institute for Advanced Studies
Department for Development, Research and HTA, Agency for Quality and Accreditation in Health Care
and Social Welfare
Syreon Research Institute
Consorci Institut D’Investigacions Biomediques August Pi i Sunyer, Hospital Clinic de Barcelona
The United Kingdom
Manchester Centre for Health Economics, University of Manchester
The SELFIE project was launched on September 1st 2015, and will continue for three more years. This project (SELFIE) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634288. The content of this blog reflects only the SELFIE groups’ views and the European Commission is not liable for any use that may be made of the information contained herein.
Fenna Leijten Maaike Hoedemakers
SELFIE Project SELFIE Project