Co-designing Integrated Care for Multimorbidity in Elective Surgical Pathways

Overview

This mixed-methods study developed a co-designed intervention to integrate care for patients with multiple long-term conditions (MLTC) into elective surgical pathways. Key findings revealed current UK pathways lack early identification and structured management of MLTC, prompting a new model focusing on early screening, referral, patient activation, optimization during waiting, and improved discharge communication.

Background

Multimorbidity affects a quarter of the UK population and is increasing globally, yet hospital care remains largely single-disease focused. Patients with MLTC undergoing elective surgery face higher risks of complications and functional decline. Surgical pathways offer a unique opportunity to optimize chronic disease management during the waiting interval before surgery. However, early identification and integration with primary care are inconsistent, limiting potential health improvements.

Data Highlights

Key Findings

• Current elective surgical pathways in the UK rarely screen for MLTC at the point of listing.
• Only 10% of hospitals have MLTC-specific care pathways, mostly focused on diabetes or anaemia.
• Preoperative assessments are often delayed, reducing time available for chronic disease optimization.
• A co-designed intervention includes a surgeon-led checklist at listing for early MLTC identification.
• Intervention components include automated referrals, patient activation materials, optimization during waiting, and structured discharge communication.
• The model aims to leverage the surgical waiting interval to improve short- and long-term patient outcomes.

Clinical Implications

Clinicians should consider implementing early screening for common long-term conditions at the time of surgical listing to allow timely optimization. Structured communication pathways between surgical teams, primary care, and specialists can enhance continuity of care. Utilizing the waiting period before surgery as an opportunity for chronic disease management may reduce postoperative complications and improve recovery.

Conclusion

This study presents a practical, co-designed model to integrate multimorbidity care into elective surgical pathways by shifting focus upstream to the point of listing. Testing this intervention in routine practice is the next step to determine its impact on patient outcomes.

References

1. NIHR/MRC Complex Intervention Framework -- Co-designing Integrated Care Approaches for Patients with Multimorbidity in Elective Surgical Pathways