Multiple Chronic Conditions

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Cynthia M. Boyd - One of the best experts on this subject based on the ideXlab platform.

  • Caring for Patients With Multiple Chronic Conditions
    Annals of Internal Medicine, 2019
    Co-Authors: Mary E. Tinetti, Ariel R. Green, Jennifer A. Ouellet, Michael W. Rich, Cynthia M. Boyd
    Abstract:

    Multimorbidity, the coexistence of Multiple Chronic Conditions, is common among all adults receiving health care and the norm among older adults. The authors discuss the limitations of disease-focu...

  • IOM and DHHS Meeting on Making Clinical Practice Guidelines Appropriate for Patients with Multiple Chronic Conditions
    The Annals of Family Medicine, 2014
    Co-Authors: Richard A. Goodman, Mary E. Tinetti, Cynthia M. Boyd, Isabelle Von Kohorn, Anand K. Parekh, J. Michael Mcginnis
    Abstract:

    BACKGROUND The increasing prevalence of Americans with Multiple (2 or more) Chronic Conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single Chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. PURPOSE In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options. RESULTS Eleven principles to improve guidelines’ attentiveness to the population with Multiple Chronic Conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of Multiple Chronic Conditions; and (3) principles intended to increase focus on patient-centered care. CONCLUSION This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with Multiple Chronic Conditions. The suggested principles are helping professional societies to improve guidelines’ attentiveness to persons with Multiple Chronic Conditions.

  • Improving the evidence base on multimorbidities through better research: a commentary on the U.S. HHS initiative, Multiple Chronic Conditions: A Strategic Framework
    2014
    Co-Authors: William A. Satariano, Cynthia M. Boyd
    Abstract:

    Multiple Chronic Conditions: A Strategic Framework” is a seminal report and the heart of a US strategic initiative, released by the U.S. Department of Health and Human Services (HHS) in December 2010, to focus the attention and resources of the US government on the research, practice, and policy implications of Multiple Chronic Conditions (MCCs).

  • health related quality of life and functional status quality indicators for older persons with Multiple Chronic Conditions
    Dy SM Pfoh ER Salive ME Boyd CM., 2014
    Co-Authors: Elizabeth R Pfoh, Marcel E Salive, Cynthia M. Boyd
    Abstract:

    To explore central challenges with translating self-reported measurement tools for functional status and health-related quality of life (HRQOL) into ambulatory quality indicators for older people with Multiple Chronic Conditions (MCCs).

  • Improving the evidence base on multimorbidities through better research: a commentary on the U.S. HHS initiative, Multiple Chronic Conditions: A Strategic Framework.
    Journal of Comorbidity, 2013
    Co-Authors: William A. Satariano, Cynthia M. Boyd
    Abstract:

    Multiple Chronic Conditions: A Strategic Framework” is a seminal report and the heart of a US strategic initiative, released by the U.S. Department of Health and Human Services (HHS) in December 2010, to focus the attention and resources of the US government on the research, practice, and policy implications of Multiple Chronic Conditions (MCCs) [1]. The specific purpose of the report is “to catalyze change within the context of how Chronic illnesses are addressed in the United States – from an approach focused on individual Chronic diseases to one that uses a Multiple Chronic condition approach” [1]. The report observes that this process represents “a culture change, or paradigm shift, and the subsequent implementation of these strategies that will provide a foundation for realizing the vision of optimal health and quality of life for individuals with Multiple Chronic Conditions” [1]. Journal of Comorbidity 2013;3(2)18–21

Kevin B. Weiss - One of the best experts on this subject based on the ideXlab platform.

  • Multiple Chronic Conditions prevalence health consequences and implications for quality care management and costs
    Journal of General Internal Medicine, 2007
    Co-Authors: Christine Vogeli, Todd A. Lee, Alexandra E. Shields, Teresa B. Gibson, William D. Marder, Kevin B. Weiss, David Blumenthal
    Abstract:

    Persons with Multiple Chronic Conditions are a large and growing segment of the US population. However, little is known about how Chronic Conditions cluster, and the ramifications of having specific combinations of Chronic Conditions. Clinical guidelines and disease management programs focus on single Conditions, and clinical research often excludes persons with Multiple Chronic Conditions. Understanding how Conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with Multiple Chronic Conditions. This Medline review of publications examining somatic Chronic Conditions co-occurring with 1 or more additional specific Chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of Multiple Chronic Conditions and the implications for quality, care management, and costs.

  • Mortality rate in veterans with Multiple Chronic Conditions
    Journal of General Internal Medicine, 2007
    Co-Authors: Todd A. Lee, Alexandra E. Shields, Christine Vogeli, Teresa B. Gibson, Min Woong-sohn, William D. Marder, David Blumenthal, Kevin B. Weiss
    Abstract:

    Background Among patients with Multiple Chronic Conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with Multiple Chronic Conditions, much less is known about the mortality rate associated with specific combinations of Multiple diseases.

  • Mortality rate in veterans with Multiple Chronic Conditions.
    Journal of general internal medicine, 2007
    Co-Authors: Todd A. Lee, Alexandra E. Shields, Christine Vogeli, Teresa B. Gibson, Min Woong-sohn, William D. Marder, David Blumenthal, Kevin B. Weiss
    Abstract:

    Among patients with Multiple Chronic Conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with Multiple Chronic Conditions, much less is known about the mortality rate associated with specific combinations of Multiple diseases. Measure the mortality rate in combinations of 11 Chronic Conditions. Cohort study of veteran health care users. Veterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000. Patients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these Conditions were created, and 5-year mortality rates were determined. There were 741,847 persons included. The number in each group by a count of Conditions was: none = 217,944 (29.34%); 1 = 221,111 (29.8%); 2 = 175,228 (23.6%); 3 = 86,447 (11.7%); and 4+ = 41,117 (5.5%). The 5-year mortality rate by the number of Conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of Conditions, there was significant variability in mortality rates. Patients with Multiple Chronic Conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of Conditions, when studying patients with Multiple coexisting illnesses, it is important to understand not only that several Conditions may be present but that specific Conditions can differentially impact the risk of mortality.

Mary E. Tinetti - One of the best experts on this subject based on the ideXlab platform.

  • Caring for Patients With Multiple Chronic Conditions
    Annals of Internal Medicine, 2019
    Co-Authors: Mary E. Tinetti, Ariel R. Green, Jennifer A. Ouellet, Michael W. Rich, Cynthia M. Boyd
    Abstract:

    Multimorbidity, the coexistence of Multiple Chronic Conditions, is common among all adults receiving health care and the norm among older adults. The authors discuss the limitations of disease-focu...

  • Guideline‐Recommended Medications and Physical Function in Older Adults with Multiple Chronic Conditions
    Journal of the American Geriatrics Society, 2017
    Co-Authors: Gail Mcavay, Heather G. Allore, Andrew B. Cohen, Danijela Gnjidic, Terrence E. Murphy, Mary E. Tinetti
    Abstract:

    Background/Objectives: The benefit or harm of a single medication recommended for one specific condition can be difficult to determine in individuals with Multiple Chronic Conditions and polypharmacy. There is limited information on the associations between guideline-recommended medications and physical function in older adults with Multiple Chronic Conditions. The objective of this study was to estimate the beneficial or harmful associations between guideline-recommended medications and decline in physical function in older adults with Multiple Chronic Conditions. Design: Prospective observational cohort. Setting: National. Participants: Community-dwelling adults aged 65 and older from the Medicare Current Beneficiary Survey study (N = 3,273). Participants with atrial fibrillation, coronary artery disease, depression, diabetes mellitus, or heart failure were included. Measurements: Self-reported decline in physical function; guideline-recommended medications; polypharmacy (taking

  • Methodology to Estimate the Longitudinal Average Attributable Fraction of Guideline-recommended Medications for Death in Older Adults With Multiple Chronic Conditions
    The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2016
    Co-Authors: Heather G. Allore, Mary E. Tinetti, Andrew B. Cohen, Yilei Zhan, Mark Trentalange, Gail Mcavay
    Abstract:

    Persons with Multiple Chronic Conditions receive Multiple guideline-recommended medications to improve outcomes such as mortality. Our objective was to estimate the longitudinal average attributable fraction for 3-year survival of medications for cardiovascular Conditions in persons with Multiple Chronic Conditions and to determine whether heterogeneity occurred by age.

  • IOM and DHHS Meeting on Making Clinical Practice Guidelines Appropriate for Patients with Multiple Chronic Conditions
    The Annals of Family Medicine, 2014
    Co-Authors: Richard A. Goodman, Mary E. Tinetti, Cynthia M. Boyd, Isabelle Von Kohorn, Anand K. Parekh, J. Michael Mcginnis
    Abstract:

    BACKGROUND The increasing prevalence of Americans with Multiple (2 or more) Chronic Conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single Chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. PURPOSE In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options. RESULTS Eleven principles to improve guidelines’ attentiveness to the population with Multiple Chronic Conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of Multiple Chronic Conditions; and (3) principles intended to increase focus on patient-centered care. CONCLUSION This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with Multiple Chronic Conditions. The suggested principles are helping professional societies to improve guidelines’ attentiveness to persons with Multiple Chronic Conditions.

  • Anti-hypertensive medications and cardiovascular events in older adults with Multiple Chronic Conditions.
    PloS one, 2014
    Co-Authors: Mary E. Tinetti, Gail Mcavay, Ling Han, David S. H. Lee, Peter Peduzzi, John A. Dodson, Cary P. Gross, Bingqing Zhou, Haiqun Lin
    Abstract:

    Importance Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have Multiple Chronic Conditions, is uncertain. Objective To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults. Design Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010. Participants and Setting 4,961 community-living participants with hypertension. Exposure Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used. Main Outcomes and Measures Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure) and mortality. Results Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1%) experienced cardiovascular events; 837 participants (16.9%) died. Of deaths, 430 (51.4%) occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89–1.32]) nor high (1.16 [0.94–1.43]) anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65–0.97] in the moderate, and 0.72 [0.58–0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48–0.87] and 0.58 [0.42–0.80] in the moderate and high intensity groups, respectively. Results were similar in the propensity score-matched subcohort. Conclusions and Relevance In this nationally representative cohort of older adults, anti-hypertensive treatment was associated with reduced mortality but not cardiovascular events. Whether RCT results generalize to older adults with Multiple Chronic Conditions remains uncertain.

Gerard F. Anderson - One of the best experts on this subject based on the ideXlab platform.

  • Multiple Chronic Conditions and life expectancy: a life table analysis.
    Medical Care, 2014
    Co-Authors: Eva H. Dugoff, Christine Buttorff, Vladimir Canudas-romo, Bruce Leff, Gerard F. Anderson
    Abstract:

    Background:The number of people living with Multiple Chronic Conditions is increasing, but we know little about the impact of multimorbidity on life expectancy.Objective:We analyze life expectancy in Medicare beneficiaries by number of Chronic Conditions.Research Design:A retrospective cohort study

  • prevalence expenditures and complications of Multiple Chronic Conditions in the elderly
    JAMA Internal Medicine, 2002
    Co-Authors: Jennifer L Wolff, Barbara Starfield, Gerard F. Anderson
    Abstract:

    Methods: A cross-sectional analysis was conducted on a nationally random sample of 1217103 Medicare feefor-service beneficiaries aged 65 and older living in the United States and enrolled in both Medicare Part A and Medicare Part B during 1999. Multiple logistic regression was used to analyze the influence of age, sex, and number of types of Chronic Conditions on the risk of incurring inpatient hospitalizations for ambulatory care sensitive Conditions and hospitalizations with preventable complications among aged Medicare beneficiaries. Results: In 1999, 82% of aged Medicare beneficiaries had 1 or more Chronic Conditions, and 65% had Multiple Chronic Conditions. Inpatient admissions for ambulatory care sensitive Conditions and hospitalizations with preventable complications increased with the number of Chronic Conditions. For example, Medicare beneficiaries with 4 or more Chronic Conditions were 99 times more likely than a beneficiary without any Chronic Conditions to have an admission for an ambulatory care sensitive condition (95% confidence interval, 86-113). Per capita Medicare expenditures increased with the number of types of Chronic Conditions from $211 among beneficiaries without a Chronic condition to $13973 among beneficiaries with 4 or more types of Chronic Conditions. Conclusions: The risk of an avoidable inpatient admission or a preventable complication in an inpatient setting increases dramatically with the number of Chronic Conditions. Better primary care, especially coordination of care, could reduce avoidable hospitalization rates, especially for individuals with Multiple Chronic Conditions.

  • Prevalence, expenditures, and complications of Multiple Chronic Conditions in the elderly
    Archives of internal medicine, 2002
    Co-Authors: Jennifer L Wolff, Barbara Starfield, Gerard F. Anderson
    Abstract:

    The prevalence, health care expenditures, and hospitalization experiences are important considerations among elderly populations with Multiple Chronic Conditions. A cross-sectional analysis was conducted on a nationally random sample of 1 217 103 Medicare fee-for-service beneficiaries aged 65 and older living in the United States and enrolled in both Medicare Part A and Medicare Part B during 1999. Multiple logistic regression was used to analyze the influence of age, sex, and number of types of Chronic Conditions on the risk of incurring inpatient hospitalizations for ambulatory care sensitive Conditions and hospitalizations with preventable complications among aged Medicare beneficiaries. In 1999, 82% of aged Medicare beneficiaries had 1 or more Chronic Conditions, and 65% had Multiple Chronic Conditions. Inpatient admissions for ambulatory care sensitive Conditions and hospitalizations with preventable complications increased with the number of Chronic Conditions. For example, Medicare beneficiaries with 4 or more Chronic Conditions were 99 times more likely than a beneficiary without any Chronic Conditions to have an admission for an ambulatory care sensitive condition (95% confidence interval, 86-113). Per capita Medicare expenditures increased with the number of types of Chronic Conditions from $211 among beneficiaries without a Chronic condition to $13 973 among beneficiaries with 4 or more types of Chronic Conditions. The risk of an avoidable inpatient admission or a preventable complication in an inpatient setting increases dramatically with the number of Chronic Conditions. Better primary care, especially coordination of care, could reduce avoidable hospitalization rates, especially for individuals with Multiple Chronic Conditions.

Simone R. De Bruin - One of the best experts on this subject based on the ideXlab platform.

  • Assigning a Prominent Role to "The Patient Experience" in Assessing the Quality of Integrated Care for Populations with Multiple Chronic Conditions.
    International Journal of Integrated Care, 2019
    Co-Authors: Mieke Rijken, Caroline A. Baan, Manon Lette, Simone R. De Bruin
    Abstract:

    In response to growing populations of citizens with Multiple Chronic Conditions, integrated care models are being implemented in many countries. Based on our experiences from three EU co-funded actions (ICARE4EU, SUSTAIN, JA-CHRODIS), we notice that users’ experiences are not always taken into account when assessing the quality of integrated care, whereas research shows that it is in this particular domain that quality improvement is most evident. The greatest value of integrated care for people with Multiple Chronic Conditions may not lie in its potential to improve their health or reduce their use of services, but in its potential to improve their care experience, by strengthening person-centred decision-making and delivering care and support accordingly. Collaborations of care providers, (representatives of) people with Multiple Chronic Conditions and researchers need to develop appropriate methods and measures to include users’ experiences in quality assessment of integrated care.

  • comprehensive care programs for patients with Multiple Chronic Conditions a systematic literature review
    Health Policy, 2012
    Co-Authors: Simone R. De Bruin, François G. Schellevis, Nathalie Versnel, Lidwien C Lemmens, Claudia C M Molema, Giel Nijpels, Caroline A. Baan
    Abstract:

    Abstract Objective To provide insight into the characteristics of comprehensive care programs for patients with Multiple Chronic Conditions and their impact on patients, informal caregivers, and professional caregivers. Methods Systematic literature search in Multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's Chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Results Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Conclusion Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with Multiple Chronic Conditions.

  • Comprehensive care programs for patients with Multiple Chronic Conditions: a systematic literature review.
    Health policy (Amsterdam Netherlands), 2012
    Co-Authors: Simone R. De Bruin, François G. Schellevis, Nathalie Versnel, Lidwien C Lemmens, Claudia C M Molema, Giel Nijpels, Caroline A. Baan
    Abstract:

    To provide insight into the characteristics of comprehensive care programs for patients with Multiple Chronic Conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in Multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's Chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with Multiple Chronic Conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.