Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile

Abstract

Background Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. Objective This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. Methods a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model’s sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. Results The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. Conclusion It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.

Person-Centered Care Model With Multimorbidity

“…Con el objetivo de medir el nivel o grado de implementación del MACEP en los centros pilotos, se desarrollaron indicadores relacionados a los componentes claves del nuevo modelo, los que se enumeran en la Tabla 2 [13] .…”

“…De esta manera se logró evaluar el progreso logrado en la implementación del modelo y los componentes menos avanzados, permitiendo establecer estrategias específicas para avanzar de acuerdo al perfil y contexto de cada CESFAM y objetivar los logros o elementos/actividades ya adquiridos.Se acordó como umbral el67% para calificar un nivel de implementación suficiente del modelo. La Tabla 3 muestra el porcentaje de implementación logrado en los siete CESFAM pilotos [13] . Con la finalidad de realizar una evaluación de carácter económico de la implementación del MACEP, se efectuó un estudio costo-consecuencia, con el apoyo del Banco Mundial.…”

Performance Measurement Systems in Primary Health Care: A Systematic Literature Review

“…This particular study highlighted the lack of usage of performance measurement systems during the COVID-19 pandemic, which negatively impacted the entire chain of primary care services (Santos, Sant'Anna & Paim, 2023). The research by Varela et al (2023) suggests that the applied measurement system, which was tested in different time periods, might have been affected by the pandemic during the second measurement.…”

Correction to: evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile

“…Following publication of the original article [ 1 ], multiple errors (missing words) were identified throughout the main text, due to a typesetting mistake.…”

“…The original article [ 1 ] has been corrected and the publisher apologises to the authors and readers for the inconvenience caused by these errors.…”