Abstract：
Multimorbidity poses an immense burden on the healthcare systems globally, whereas the management strategies and guidelines for multimorbidity are poorly established. We aim to synthesize current evidence on interventions and management of multimorbidity.
We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system.
A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients\' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized.
Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity.
We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system.
A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients\' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized.
Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity.
摘要：
背景：多症对全球医疗保健系统造成了巨大负担，而多发病率的管理策略和指南尚不完善。我们的目标是综合目前关于多症干预和管理的证据。
方法：我们搜索了四个电子数据库(PubMed，Embase,WebofScience,和Cochrane系统评价数据库)。纳入并评估了多重性疾病干预或管理的SRs。通过AMSTAR-2工具评估每个SR的方法学质量，通过建议评估的分级来评估干预措施有效性的证据质量，开发和评估(等级)系统。
结果：共纳入30个SRs（464个独特的基础研究），包括20份干预措施和10份总结多症管理证据的SRs。确定了四类干预措施：患者级干预措施，提供者级别的干预措施，组织层面的干预，和联合干预措施(结合上述两个或三个层面的组成部分)。结果分为六种类型：身体状况/结果，精神状况/结果，社会心理结果/一般健康，医疗保健利用率和成本，患者的行为，和护理过程的结果。联合干预措施（包括患者级别和提供者级别的组成部分）在促进身体状况/结果方面更有效，而患者层面的干预措施在促进精神状况/结局和心理社会结局/一般健康方面更有效.至于医疗保健利用和护理过程结果，组织层面和联合干预措施(与组织层面的组成部分)更有效.患者多发病管理的挑战，还总结了提供者和组织级别。
结论：不同级别的综合干预措施将有利于促进不同类型的健康结果。患者的管理存在挑战，提供者,和组织层面。因此,一种整体和综合的患者方法-，需要提供者和组织层面的干预措施来应对挑战并优化对多病患者的护理。
方法：我们搜索了四个电子数据库(PubMed，Embase,WebofScience,和Cochrane系统评价数据库)。纳入并评估了多重性疾病干预或管理的SRs。通过AMSTAR-2工具评估每个SR的方法学质量，通过建议评估的分级来评估干预措施有效性的证据质量，开发和评估(等级)系统。
结果：共纳入30个SRs（464个独特的基础研究），包括20份干预措施和10份总结多症管理证据的SRs。确定了四类干预措施：患者级干预措施，提供者级别的干预措施，组织层面的干预，和联合干预措施(结合上述两个或三个层面的组成部分)。结果分为六种类型：身体状况/结果，精神状况/结果，社会心理结果/一般健康，医疗保健利用率和成本，患者的行为，和护理过程的结果。联合干预措施（包括患者级别和提供者级别的组成部分）在促进身体状况/结果方面更有效，而患者层面的干预措施在促进精神状况/结局和心理社会结局/一般健康方面更有效.至于医疗保健利用和护理过程结果，组织层面和联合干预措施(与组织层面的组成部分)更有效.患者多发病管理的挑战，还总结了提供者和组织级别。
结论：不同级别的综合干预措施将有利于促进不同类型的健康结果。患者的管理存在挑战，提供者,和组织层面。因此,一种整体和综合的患者方法-，需要提供者和组织层面的干预措施来应对挑战并优化对多病患者的护理。
