The Foundations Framework for developing and reporting new models of care for multimorbidity

Purpose
Multimorbidity is a challenge for health systems globally. New models of care are urgently needed to better manage patients with multimorbidity. However, there is no agreed framework to support development and reporting of models of care for multimorbidity and their evaluation.

Methods
We used a literature search to identify models of care for multimorbidity. We developed a framework to describe these models. We illustrate the application of the framework by identifying the focus and gaps in current models of care, and by describing the evolution of models over time.

Results
The framework describes each model in terms of its theoretical basis and target population (the foundations of the model), and elements of care implemented to deliver the model. We categorised elements of care into three types: (a) clinical focus; (b) organisation of care; (c) support for model delivery. Application of the framework identified a limited use of theory in model development and a strong focus on some patient groups (elderly, high users) more than others (younger patients, deprived populations). We identified changes in elements over time, with a decrease in models implementing home care, and an increase in models offering extended appointments.

Conclusions
By encouraging greater clarity about underpinning theory and target population, and categorising the wide range of potentially important elements of an intervention to improve care for patients with multimorbidity, the framework may have utility in the development and reporting of models of care. This will help ensure the effective development of the currently limited evidence base