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Review
. 2018 Jul 24;18(1):576.
doi: 10.1186/s12913-018-3367-4.

Strengthening the evidence-base of integrated care for people with multi-morbidity in Europe using Multi-Criteria Decision Analysis (MCDA)

Maureen Rutten-van Mölken  1   2 , Fenna Leijten  3 , Maaike Hoedemakers  3 , Apostolos Tsiachristas  3   4 , Nick Verbeek  3 , Milad Karimi  3 , Roland Bal  3 , Antoinette de Bont  3 , Kamrul Islam  5 , Jan Erik Askildsen  5 , Thomas Czypionka  6 , Markus Kraus  6 , Mirjana Huic  7 , János György Pitter  8 , Verena Vogt  9 , Jonathan Stokes  10 , Erik Baltaxe  11 ; SELFIE consortium
Affiliations
Review

Strengthening the evidence-base of integrated care for people with multi-morbidity in Europe using Multi-Criteria Decision Analysis (MCDA)

Maureen Rutten-van Mölken et al. BMC Health Serv Res. .

Abstract

Background: Evaluation of integrated care programmes for individuals with multi-morbidity requires a broader evaluation framework and a broader definition of added value than is common in cost-utility analysis. This is possible through the use of Multi-Criteria Decision Analysis (MCDA).

Methods and results: This paper presents the seven steps of an MCDA to evaluate 17 different integrated care programmes for individuals with multi-morbidity in 8 European countries participating in the 4-year, EU-funded SELFIE project. In step one, qualitative research was undertaken to better understand the decision-context of these programmes. The programmes faced decisions related to their sustainability in terms of reimbursement, continuation, extension, and/or wider implementation. In step two, a uniform set of decision criteria was defined in terms of outcomes measured across the 17 programmes: physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centeredness, continuity of care, and total health and social care costs. These were supplemented by programme-type specific outcomes. Step three presents the quasi-experimental studies designed to measure the performance of the programmes on the decision criteria. Step four gives details of the methods (Discrete Choice Experiment, Swing Weighting) to determine the relative importance of the decision criteria among five stakeholder groups per country. An example in step five illustrates the value-based method of MCDA by which the performance of the programmes on each decision criterion is combined with the weight of the respective criterion to derive an overall value score. Step six describes how we deal with uncertainty and introduces the Conditional Multi-Attribute Acceptability Curve. Step seven addresses the interpretation of results in stakeholder workshops.

Discussion: By discussing our solutions to the challenges involved in creating a uniform MCDA approach for the evaluation of different programmes, this paper provides guidance to future evaluations and stimulates debate on how to evaluate integrated care for multi-morbidity.

Keywords: Cost; Economic evaluation; Integrated care; Multi-criteria decision analysis; Multi-morbidity; Outcomes; Triple aim.

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Conflict of interest statement

Ethics approval and consent to participate

Letters of Medical Ethics Approval of study protocols, questionnaires and informed consent forms were send to and approved by the European Commission as a Deliverable of the SELFIE project.

Austria: Letter from Institute for Advanced Studies (IHS) declaring that ethical approval is not necessary for the evaluation of the two Austrian Integrated Care programmes, 3–10-2017.

Croatia: Statement from the Agency for Quality and Accreditation in Health Care and Social Welfare declaring that the two evaluation studies are not within the scope of work of Croatian Central Ethics Committee, 28–8-2017, with reference to Official Gazette No. 121/07 and No. 25/15.

Germany, Gesundes Kinzigtal: Letter from the Ethical Committee, Technische Universität Berlin, declaring that the research is ethically acceptable. Ref: ST_02_20170620, 15–8-2017.

Germany, Casaplus: Letter from the Ethical Committee, Technische Universität Berlin, declaring that the research is ethically acceptable. Ref: ST_01_20170428, 4–8-2017.

Hungary, Onkonetwork: Letter from the Medical Research Council (Tudomanyos es Kutatasetikai Bizottsag, ETT TUKEB) declaring that the research is granted with Professional-Ethical Approval, Ref: 12412–2/2017/EKU, 2–3-2017.

Hungary, Palliative Care Consult Service: Letter from the Medical Research Council (Tudomanyos es Kutatasetikai Bizottsag, ETT TUKEB) declaring that the research is granted with Professional-Ethical Approval, Ref: 18632–4/2017/EKU, 24–4-2017.

Netherlands, Proactive Primary Care Approach for Frail Elderly (U-PROFIT): Letter from the Medical Ethical Committee (MEC) Erasmus Medical Center Rotterdam declaring that the research is exempt from the Medical Research Involving Human Subjects Act (Dutch acronym: WMO). Ref: MEC-2017-402, 25–7-2017.

Netherlands, Care Chain Frail Elderly (CCFE): Letter from the Medical Ethical Committee (MEC) Erasmus Medical Center Rotterdam declaring that the research is exempt from the Medical Research Involving Human Subjects Act (Dutch acronym: WMO). Ref: MEC-2014.558, 18–12-2014.

Netherlands, Better Together in Amsterdam North (BSiN): Letter from the Medical Ethical Committee (MEC) of the Free University Medical Centre declaring that the research is exempt from the Medical Research Involving Human Subjects Act (Dutch acronym: WMO). Ref: MEC-2017-121, 10–3-2017.

Norway, Learning Network for Whole, Coordinated and Safe Pathways: Letter from the Regional Committees for Medical and Health Research Ethics-West (Komité for medisinsk og helsefaglig forskningsetikk -REK vest), declaring that the research is ethically approved. Ref: 2017/632/REK vest, 28–3-2017.

Norway, Medically Assisted Rehabilitation Bergen: Letter from The Regional Committees for Medical and Health Research Ethics- West (Komité for medisinsk og helsefaglig forskningsetikk -REK vest), declaring that the research is ethically approved. 2017/944/REK vest, 21–6-2017.

Spain, Barcelona-Esquerra (AISBE): Letter from Clinic Research Ethical Committee (Comitè Ètic d’Investigació Clinica - CEIC) of the Clinic Hospital of Barcelona, Ref: CIF-G-08431173, Reg. HCB 2017/0451, 14–6-2017.

Spain, Badalona Serveis Assistencials (BSA): Letter from Clinic Research Ethical Committee (Comitè Ètic d’Investigació Clinica - CEIC) of the Clinic Hospital of Barcelona, Ref: CIF-G-08431173, Reg. HCB 2017/0453, 14–6-2017.

UK: Letter of study approval from the University of Manchester Research Ethics Committee (UREC), Ref: 2017–0864-3251, 20–6-2017.

All participants provide written informed consent before participation.

Consent for publication

Not applicable.

Competing interests

The authors have no competing interests.

Publisher’s Note

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Figures

Fig. 1
Fig. 1
Geographic overview of selected 17 programmes
Fig. 2
Fig. 2
Example of a DCE question in the UK
See this image and copyright information in PMC

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