A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings

Pathologic and Risk Analysis of the Lojuela Castle (Granada-Spain): Methodology and Preventive Conservation for Medieval Earthen Fortifications

This study presents a methodology generated for the preventive conservation of defensive earthen architecture, applied to the case of the Lojuela Castle (Lecrin Valley, Granada, Spain). In the application of the designed protocol, a multidisciplinary analysis of its patrimonial characteristics and multidimensional evaluation was developed, applying the technique of qualitative consultation to a group of experts—the Delphi method. This methodology allowed us to relate the hazard factors and the vulnerability of the asset for each group of risks that a ect it. The support of the method in with geographic information systems (GIS) has favored the production of predictive cartography and risk analysis—including the territorial dimensions and spatial interactions of the asset with the physical environment. This has facilitated the obtention of micro-zoning maps of each of the risks examined. The risk mapping in micro-zoning and the knowledge of the structure’s vulnerability represents an important contribution to the future conservation and management of this heritage. They favor strategies that minimize the incidence of risks and allow the prioritization of the conservation actions with a minimum economic investment, creating an e cient maintenance program. This will facilitate the protection, conservation and valorization decisions by the administration and the competent bodies involved in the protection of these sites.State Research Agency (SRA) BIA2015 69938-REuropean Union (EU