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Open Access 01-12-2018 | Research article

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

Authors: Maureen Rutten-van Mölken, Fenna Leijten, Maaike Hoedemakers, Apostolos Tsiachristas, Nick Verbeek, Milad Karimi, Roland Bal, Antoinette de Bont, Kamrul Islam, Jan Erik Askildsen, Thomas Czypionka, Markus Kraus, Mirjana Huic, János György Pitter, Verena Vogt, Jonathan Stokes, Erik Baltaxe, on behalf of the SELFIE consortium

Published in: BMC Health Services Research | Issue 1/2018

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.

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Title: Strengthening the evidence-base of integrated care for people with multi-morbidity in Europe using Multi-Criteria Decision Analysis (MCDA)
Authors: Maureen Rutten-van Mölken
Fenna Leijten
Maaike Hoedemakers
Apostolos Tsiachristas
Nick Verbeek
Milad Karimi
Roland Bal
Antoinette de Bont
Kamrul Islam
Jan Erik Askildsen
Thomas Czypionka
Markus Kraus
Mirjana Huic
János György Pitter
Verena Vogt
Jonathan Stokes
Erik Baltaxe
on behalf of the SELFIE consortium
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3367-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods and results

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods and results

Discussion

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