Supervisor: Lijing L. Yan, Professor of Global Health
Student Researchers: Juntian Shen (Class of 2025), Xulei Huang (Class of 2025), Yuxuan Zhou (Class of 2026)
About the Project:
Multimorbidity (≥2 co-existing health conditions in an individual) is a growing global challenge with a substantial impact on individuals, care providers, and healthcare systems (Skou et al., 2022). Global studies have shown that multimorbidity is linked with frailty and polypharmacy, with consequences of reduced quality of life and higher mortality (Zhong et al., 2023). Multimorbidity is also proven to precipitate a substantially higher burden on healthcare systems and social care costs (Picco et al., 2016).
In China, 46.5% of adults (aged 18 or older) had multimorbidity in 2018, and the prevalence of multimorbidity increases with age (Geng et al., 2018). As China’s population aging deepens, it is projected that multimorbidity will become a larger problem in the future. Therefore, China’s 14th Five Year Plan has integrated the management of multimorbidity into its health agenda (Zhang et al., 2022). The high prevalence of multimorbidity and the large number of people with multimorbidity needing care make the reliance on specialist services not feasible or effective. Strengthening primary care and community-based services is the essential solution for not only individual non-communicable chronic diseases (NCDs) (such as hypertension and diabetes) (Prados-Torres et al., 2014) and pandemics (such as COVID-19) control but also for multimorbidity management (3Ms). Hypertension and diabetes are the most common NCDs already included in the basic public health service package delivered by primary care centers in China.
Intrinsic capacity (IC), defined as “the composite of all the physical and mental capacities of an individual”, is a key concept proposed by WHO (World Health Organization, 2015). Despite the urgent call by WHO and Chinese experts for person-centered integrated care for older patients with multimorbidity based on IC (Zhu et al., 2023), epidemiologic studies and intervention trials on the topics are scarce. To fill in these gaps, our project is structured into three key components:
(1) Quantitative analysis:
Using a nationally representative cohort of Chinese older adults followed over 20 years, we aim to examine the interaction between IC and multimorbidity and their combined impact on adverse health outcomes through statistical modeling. Our findings are expected to enhance risk stratification and inform the design of effective interventions for multimorbidity management in China’s aging population.
(2) Systematic review:
A systematic review has been conducted to synthesize evidence on the effectiveness of integrated and multi-domain interventions aimed at enhancing IC for multimorbidity management. This review will address the pressing need for holistic and coordinated multimorbidity care approaches. By examining existing studies, we expect to identify effective strategies that improve health outcomes, enhance quality of life, and optimize healthcare utilization for individuals with multimorbidities.
(3) Qualitative research:
To gain a deeper understanding of the real-world challenges and perspectives, we also conducted qualitative research based on the Capacity Opportunity Motivation-Behavior (COM-B) model (Michie et al., 2014) and semi-structured interviews on cardiometabolic multimorbidity management at the personal, community, and city levels in Kunshan, China. By engaging with patients, family members, and family physicians, we seek to uncover barriers and facilitators in the primary healthcare system, providing actionable insights for the implementation of effective multimorbidity management strategies in the future.
References
Michie S, Atkins L, West R. (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing. www.behaviourchangewheel.com
World Health Organization. (2015). World report on ageing and health. World Health Organization. https://apps.who.int/iris/handle/10665/186463
Zhu, M., Liu, D., Dong, B., Qin, M., & Chen, Q. (2023). Chinese expert consensus on management of elderly patients with multimorbidity. Chinese Journal of Clinical Healthcare, 26(5), 577–584. https://qikan.cqvip.com/Qikan/Article/Detail?id=7110881937
