Rethinking health services around clusters of co-existing diseases: impact on integrated care for people with Multiple Long-Term Conditions

Abstract (up to 300 words) Background Care delivery in conventional health systems is structured around clinical anatomical specialties, often geared towards managing single conditions rather than people. As a result, people with Multiple Long-Term Conditions (MLTC) often need to see many different specialists to manage their health, resulting in fragmented care that is inefficient and costly. Certain Long-term Conditions (LTCs) frequently co-exist in identifiable clusters. Here, we examine the impact on the number of interactions with distinct healthcare services per person with MLTC if care was organised around common clusters of co-existing conditions, rather than anatomical specialties.  Methods and findings We used a nationally representative sample of electronic health records from general practices in England. Patients aged ≥18 years and registered on 1st January 2020 with MLTC (two or more of 212 LTCs) were included. Each LTC was assigned to one of fifteen systems representing the conventional ‘specialty-based’ model of care and to one of fifteen clusters, derived from earlier work, representing a ‘cluster-based’ model of care. We calculated the number of interactions with distinct services under each model, assuming a person has a hospital appointment for each of their conditions. 7,122,447 adults were included, with a median (interquartile range) age of 54 (39 - 67) years. Under the specialty-based model, patients would interact with a mean (standard deviation) of 3.91 (2.02) different services and under the hypothetical cluster-based model, would interact with 3.51 (1.76) different services, 10.1% lower than under the specialty-based model (p<0.001). Under the specialty-based model, 419,252 (5.9%) patients interacted with only one service, and under the cluster-based model, 594,641 (8.3%) interacted with only one service.  Conclusions Hospital services organised around clusters of co-existing conditions might allow patients with MLTC to interact with fewer different services and so improve integrated care. Further work is needed to understand which specialties collaborating, and how, would have the greatest impact on enhancing person-centred care and health outcomes.