Posted by: ihfgeneva | October 21, 2013

Hospitals and Multi-morbid Chronic Conditions

Hospitals Multi-morbid chronicThrough a White Paper written by Dr. Paul Dugdale, Director of the Center for Health Stewardship at the Australian National University, Matthew Kelly, student at Johns Hopkins University /Intern at the International Hospital Federation and Clare King, Public Health Physician at the Canberra Hospital and Health Services, the International Hospital Federation highlights the issue of multi-morbid chronic conditions and the need for patient-centered care in hospitals today. Due to the shift of disease burden from communicable, maternal, neonatal and nutritional disorders to non-communicable diseases, it is crucial for healthcare systems to address this issue by shifting their focus from individual episodic patient events to a continuum of patient-centered care.

The IHF emphasizes the importance of the primary healthcare role of hospitals. It is especially important for hospitals to reorient themselves to provide patients with more holistic care, specifically for those living with multi-morbid chronic conditions. Although this is currently a challenge for hospital management, technology developments in information sharing for patient centered clinical care can help improve the situation.

In order to address this issue, there must be a paradigm shift in hospital management, which must include new modalities of interventions, changes in the education and roles of health professionals and emergence of new occupational groups. Hospital management will also have to improve its collaboration with primary health centers and community based services, in order to create a continuity of care for patients living with multi-morbid chronic conditions as they move around between various service delivery settings.

In order to address the issue of multi-morbid chronic care in hospitals, health system financing must also be focused on. Universal health coverage for comprehensive care can fund care for people living with multi-morbid chronic conditions, and government supported health coverage systems increase accessibility for those living with chronic conditions and may consequently be unemployed. Fee for service financing usually increases access to patients, however it often incentivizes over-service and skews distribution to wealthier communities. On the other hand, capitation based payments often undermine access as healthcare providers are incentivized to provide less services. Healthcare financing will be an obstacle in addressing multi-morbid chronic care, and will have to be addressed using historical and economical characteristics of each specific healthcare system.

Although there are obstacles to shifting hospital management to address multi-morbid chronic conditions, there is optimism for the future. Improvements are being made and hospitals are moving from focusing on individual care events to the continuum of patient-centered care. It will be important for hospitals and the primary care sector to consider the patient’s point of view when providing a continuum of care through multi-disciplinary teams.

A full text of Hospitals and Multi-morbid Chronic Conditions can be found at:


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