Integrated care for people with multimorbidity into elective surgical pathways: mixed-methods co-design study.
Abstract
BACKGROUND: People with multiple long-term conditions (MLTC) commonly undergo elective surgery, yet current pathways remain poorly equipped to meet their complex needs. These pathways present a unique, time-sensitive opportunity to act. The aim of this study was to co-design a feasible intervention that integrates MLTC care into surgical pathways.
METHODS: This was a theory-informed mixed-methods co-design study (informed by the National Institute for Health and Care Research (NIHR)/Medical Research Council (MRC) complex intervention framework). Phase 1 involved contextual analysis of current UK pathways (pathway mapping, policy/guideline scan, and national survey) and phase 2 involved multidisciplinary stakeholder workshops to develop a Theory of Change.
RESULTS: In phase 1, pathway mapping identified variation and delayed preassessment, resulting in a limited window to optimize chronic diseases. The scoping review found no UK guidance integrating MLTC into surgical pathways. In the survey (73 responses, 51 National Health Service (NHS) Trusts), few services screened at listing and structured pathways were uncommon. Only one-in-ten hospitals had an MLTC-specific care pathway for elective surgical patients, primarily focusing on diabetes or anaemia management. In phase 2, 21 stakeholders agreed upon a pragmatic intervention prioritized on four domains (diabetes, hypertension, weight management, and smoking cessation), with five intervention components: surgeon-led checklist-based early identification at listing; automated referral to primary care/specialist services; patient-activation materials; optimization during waiting time; and structured discharge communication.
CONCLUSION: This study presents a co-designed model that shifts MLTC care upstream to the point of listing, offering the potential to improve short- and long-term health.
Many people coming into hospital for planned surgery also live with more than one long-term health condition, such as diabetes, high blood pressure, or weight problems. Current hospital pathways are not well set up to deal with this complexity. Often, health checks happen only a few weeks before the operation, leaving little time to make changes that could improve safety and recovery. In this study, the authors worked with patients, surgeons, anaesthetists, nurses, GPs, and other specialists to design a new way of organizing care. Together, they created a checklist that starts at the point when surgery is first scheduled. The checklist helps the team pick up common health problems earlier, pass information to primary care or specialist clinics, give patients clear support materials, use the waiting interval for optimization, and ensure better discharge communication. This new model aims to make existing resources work harder, by using the surgical waiting interval as a chance to address long-term conditions. It is designed to be simple, practical, and easy to fit into current NHS systems. The next step is to test whether it is workable in everyday practice and whether it truly improves health outcomes for patients after surgery.
Date
2025-11-06
Type
Article
Subject
Continuity of Patient Care, Multiple Chronic Conditions, Elective Surgical Procedures
Collections
Citation
Kamarajah SK, Dhesi J, Khunti K, Nirantharakumar K, Cockwell P, Hughes C, Stern P, Yeung J, Morton DG, Bhangu AA, Ahuja S. Integrated care for people with multimorbidity into elective surgical pathways: mixed-methods co-design study. Br J Surg. 2025 Nov 6;112(11):znaf246. doi: 10.1093/bjs/znaf246.
Journal / Source Title
The British journal of surgery
DOI
10.1093/bjs/znaf246
PMID
41218980
Publisher
Oxford University Press on behalf of BJS Foundation Ltd.
Publisher’s URL
https://academic.oup.com/bjs