Borgermans L, De Maeseneer J, Wollersheim H, Vrijhoef B, Devroey D. A theoretical lens for revealing the complexity of chronic care. Perspect Biol Med. 2013;56(2):289-299.
Eerste auteur: Borgermans L.
Jaar: 2013
Type: Publicatie
Abstract:
The increasing prevalence of co-occurring multiple chronic conditions in an ageing population has influenced the debate on complexity in chronic care and provides nowadays an impetus to the reform of numerous health systems. This paper presents a theoretical lens for the understanding of complexity of chronic care based on research and debate conducted in the context multiple quality improvement programmes over the last five years in Belgium and the Netherlands. We consider four major components of complexity in chronic care against a background of complex adaptive systems. These components are: 1) case (patient) complexity; 2) complexity of the care processes provided; 3) the complexity of quality assessment; and 4) complexity at the health system level. Each of these components represents a range of elements that contribute to the picture of complexity in chronic care.We emphasize that planning for chronic care requires equal attention to the complexity of both the case and the intended care, as well as for quality assessment and health systems complexity. This requires multifaceted interventions and implementation strategies that target improvements in multiple outcomes related to the structural, process and outcome components of care. Further empirical research is needed to assess the validity of our complexity framework in the healthcare environment.