A model to improve the appropriateness in the management of acute poly-pathological patients: the Acute Complex Care Model

Improved care for acute diseases has increased mean age and the proportion of people affected by multiple chronic diseases, while mutated socioeconomic conditions augmented the number of elderly and socially frail subjects. Multi-morbid patients who require a global approach not-fragmented-care interventions and a close connection between health and social services are progressively growing. Acute Complex Care Model (ACCM) is a model of integrated management of the frail patients when they need acute hospital care. The name of our model - ACCM - just recalls the chronic care model (CCM), designed for the de-hospitalization of chronic patients by preventing acute exacerbations, representing the hospital counterpart of the CCM. The target population is made up of acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring high technological resources and continuous monitoring; the mission is to improve the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patient-centered approach. Nowadays, multiple uncoordinated specialists care for AICPPs who move from one ward to another, with dangerous loss of information and continuity. ACCM tries to overcome these problems by putting the internal medicine specialist as the only referent for that patient and the coordinator of the care team. According to a model of future hospital organized with different intensity settings, the Internal Medicine Wards, caring for AICPPS, are organized in High Dependency Areas and Ordinary Areas. For both we present organizational and personnel standards that are lacking in daily practice. The epidemiological transition leading to a progressive increase in AICPPs requiring frequent hospitalization enhances the role of hospital internal medicine specialist in the coordination and delivery of care. The ACCM represents a practical response to this epochal change of roles. Medical and nursing staff standards and competencies have to be reviewed to ensure adequate care for these patients.