International research network on quality of care for chronic conditions (CCCQ)

The proposed research network is a product of engagement of international experts and stakeholders in a recently-concluded programme of work by the Health Policy Unit of the Institute of Tropical Medicine, commissioned by the World Health Organization, on quality of care for chronic conditions. Experts and stakeholders with field exposure covering 97 countries were convened in a Delphi Survey. Some of the participants were also involved in a Research-Policy Workshop (Meeting the Demands for Healthcare Related to Non-Communicable Diseases in LMICs) organized by the WHO, the University of Lausanne and the Erasmus University of Rotterdam in November 2022.

Chronic conditions – whether noncommunicable or infectious in nature – are broadly defined as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.

They account for almost three quarters of deaths around the world. Chronic conditions raise particular issues in terms of delivery of quality care. For instance, one should try to offer to persons with chronic conditions (PwCC) a seamless journey in the health system across services, providers, levels of care, etc. It is thus crucial to give sufficiently tailored, detailed and comprehensive meaning to care integration and continuity of care (for a seamless journey), to acknowledge the reality of multimorbidity, and to support the needs of people with chronic conditions considering not only biomedical/clinical but also psychosocial aspects to adapt and self-manage in the face of social, physical, and emotional challenges.

As part of the work commissioned by the WHO, Ku, Van de Put, Katsuva, Ag-Ahmed and Meessen constructed a framework for quality of care for chronic conditions (the CCCQ Framework). The framework proposes seven quality aims (effectiveness; efficiency; equitability; timeliness, affordability, and accessibility; safety; person-centredness; and continuity). It is expected that actions need to be organized around health system building blocks (leadership and governance; health financing; resources such as medicines, diagnostics and people including human resources for health and PwCC; and service delivery) to achieve the quality aims. Achievement of the aims can then be measured through structure, process, and outcome attributes.

As a next step, we anticipate that our framework will help experts around the world who are committed to quality in chronic care, in designing, testing (through research) and implementing new interventions, particularly in low- and middle-income countries where the burden of chronic conditions are highest, structural barriers to access to care or to medicines are more common, and challenges in policy formulations for and implementation of good quality care are not unusual.

Such design, research and implementation activities will benefit from a network, for:

1. pooling of expertise (e.g., expertise in quality in healthcare, health economics, health financing, implementation research, geriatrics and frailty in ageing, primary care, health systems, and health policy-related expertise including pharmaceutical policies and systems) and varied experiences across different settings;

2. exchange of ideas and reciprocal learning (North-South, South-North, South-South, North-North);

and

3. the advancement of relevant global and local policies concerning care and attention to chronic conditions.