Table 1.

Summary of our approach to evidence synthesis and stakeholder and citizen engagement

Project	Objective	Key methodological features
Knowledge synthesis	Synthesize the available research evidence about optimal treatment approaches for people with multimorbidity	Included four types of documents: (1) systematic reviews evaluating the health risks faced by people with multimorbidity and/or programs and models for their treatment; (2) guidelines (or approaches to developing guidelines) outlining approaches for treating people with multimorbidity; (3) effectiveness studies evaluating programs and models for treating people with multimorbidity; and (4) process evaluations of programs and models for treating people with multimorbidity Conducted database searches,* hand-searched websites of relevant Canadian and international organizations, and asked key informants for literature Two independent reviewers assessed all literature for inclusion Extracted the focus and key findings from each document, and appraised the methodological quality of all systematic reviews (using the AMSTAR tool) (Shea et al. 2007)
'Gap analysis'	Identify key knowledge gaps that could be the focus for future research	Updated all of the literature searches (in March 2014) Developed a 'gap map'§ by organizing the included reviews and economic evaluations in a matrix by mapping each review according to the level of intervention in the system (at the level of patients or individuals, providers, teams, organizations, sectors or systems) and to outcomes included within the Institute for Healthcare Improvement's Triple Aim Initiative (improving the patient experience of care, improving the health of populations and reducing the per capita cost of care) (Institute for Healthcare Improvement 2014)
Issue and citizen brief	Package the available evidence for stakeholders and citizens	Convened a steering committee and conducted key informant interviews to inform the development of the brief Updated searches from the knowledge synthesis and synthesized the findings related to the problem, three elements of a potentially comprehensive approach to address the problem, and implementation considerations
Stakeholder dialogue	Identify shared ground, divergences of opinion and possible next steps tc address the issue	Convened health system stakeholders (policy makers, managers of health organizations, professional and community leaders, patients/citizens/groups representing them, and researchers) for deliberations to support participants to champion creative efforts to design integrated approaches to support people with multimorbidity Participants were identified in collaboration with a steering committee and selected based on their ability to: (1) bring unique views, experiences and tacit knowledge to bear on the challenge and learn from the research evidence and from others' views, experiences and tacit knowledge; and (2) champion within their respective constituencies the actions that will address the challenge creatively Deliberations were facilitated by one of us (JNL) and followed the structure of the issue brief, with a final deliberation focused on next steps that could be taken for different constituencies Followed the Chatham House Rule (i.e., ‘the information used during the meeting can be used, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed’) (Chatham House 2014) Conducted a thematic analysis of the deliberations
Citizer panel	Identify the values anc preferences that citizens believe should guide next steps	Sought to recruit a panel of 10-14 citizens¶ in Ontario that was balanced in terms of gender, age, socioeconomic status and lived experience (i.e., balance between those with one chronic disease, with two or more chronic diseases, and those caring for someone with a chronic disease) Participants were recruited through an organization that maintains a panel of approximately 250,000 Canadians who participate in loyalty programs The deliberations were facilitated by one of us (FPG) and followed the structure of the citizen brief Prepared a thematic summary of the deliberations, with specific focus on identifying underlying values and preferences expressed by participants

^*We conducted a related articles search of PubMed in June 2012 using each of the 10 studies included in a recent systematic review (Smith et al. 2012) and a hand search of the excluded references in the review. The PubMed search was limited to articles published in 2011 or later (the year the search was last conducted in the review). We also searched Medline in September 2012 using the ‘co-morbidity' MeSH term (as the focus of the document) and limiting the search to the last 10 years (2002 to 24 September 2012).

^§We used the approach developed by the International Initiative for Impact Evaluation (International Initiative for Impact Evaluation 2014).

^¶We excluded employees of healthcare organizations or healthcare professionals, elected officials, and individuals working for market research, advertising, public media or public relations firms.