title: Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients.
abstract: BACKGROUND
  Chronic diseases are the major cause of death (59%) and disability worldwide, representing 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards. The Hospital Acute Care Hub will bring together the clinical areas of the MD that focus on the management of acute medical patients. The Chronic Care Model (CCM) places the patient at the center of the care system enhancing the community's social and health support, pathways and structures to keep chronic, frail, poly-pathological people at home or out of the hospital. The management of such patients in the hospital still needs to be solved. Hereby, we propose an innovative model for the management of the hospital's acute complex patients, which is the hospital counterpart of the CCM.
  The target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring high technology resources. The mission is to improve the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patient-centered approach. The ACCM leader is an internal medicine specialist (IMS) who summarizes health problems, establishes priorities, and restores health balance in AICPPs.
  
  
  CONCLUSIONS
  The epidemiological transition leading to a progressive increase in "chronically unstable" and complex patients needing frequent hospital treatment, inevitably enhances the role of hospital IMS in the coordination and delivery of care. ACCM represents a practical response to this epochal change of roles.
authors.affiliation: UOC Medicina 1. Ospedale S. Eugenio ASL Roma C, Roma, Italy. Electronic address: filomena.pietrantonio@gmail.com.
authors.forename: Filomena
authors.initials: F
authors.lastname: Pietrantonio
authors.affiliation: SC Medicina Interna 1, Ospedale S. Andrea, ASL5 "Spezzino", La Spezia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Orlandini
authors.affiliation: Azienda Ospedaliera S. Giovanni-Addolorata, UOC Medicina 1 per l'Urgenza, Roma, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Moriconi
authors.affiliation: SC Medicina Interna 1, Ospedale S. Andrea, ASL5 "Spezzino", La Spezia, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: La Regina
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D019468:Disease Management; D018450:Disease Progression; D006301:Health Services Needs and Demand; D006801:Humans; D017146:Models, Organizational; D000067251:Symptom Flare Up
keywords: Acute medicine; Chronic Care Model; Core competencies in internal medicine; Internal medicine role; Poly-pathological patients