Research on Multiple Chronic Conditions

Topic: Risk, prevention and care in population studies

This issue of Medical Care includes a theoretical framework for conducting research on MCC, a review of existing MCC research methods and methodological gaps to be addressed, and the results of several research studies addressing MCC. Maciejewski and Bayliss5 suggest that quasiexperimental designs using large databases will be the workhorse design of the MCC field. Importantly, they showed that patients with the most common combinations of conditions (eg, diabetes, hyperlipidemia, and hypertension) are not the most costly. The authors conclude that patient and provider beliefs and preferences weigh heavily in statin prescribing decisions. In a sample of Veterans Administration (VA) patients with depression, some comorbidities (eg, cardio/cerebrovascular disease, peptic ulcer/GERD, or arthritis) increased the likelihood of receiving guideline-concordant care, whereas others (eg, substance or alcohol abuse) decreased the likelihood of receiving guideline-concordant care.16 Similarly, Domino et al17 showed that cancer screening and quality measures for single disease were generally lower among persons with MCC who also had mental illness, compared with those without mental illness. These findings emerged from an analysis of integrated Medicaid and mental health system data from the AHRQ-funded North Carolina Integrated Data for Researchers. Domino et al17 argue that quality of care for patients with behavioral conditions can serve as a benchmark for overall quality of care for all persons with MCC. The findings of these 3 studies suggest that specific morbidities such as behavioral health conditions and substance abuse may be sources of health disparity. As for other causes of health disparity, however, the reasons for and the outcomes associated with these variations warrant further investigation. The results of 2 studies address the appropriateness of extrapolating evidence of treatment effect from younger to older or from healthier to sicker populations. Prior research found that targeting normal hematocrit levels versus lower levels resulted in worse clinical outcomes in patients with ESRD. As a result, clinicians now typically aim for hematocrits in the 34.5%–39% range, although no evidence supports the use of this level versus lower hematocrit levels. Zhang and colleagues compared outcomes from ESRD patients with the middle-range hematocrit target versus outcomes for patients with hematocrits in the 30%–34.5% range. Their study showed no statistically s

Key findings

• This issue of Medical Care includes a theoretical framework for conducting research on MCC, a review of existing MCC research methods and methodological gaps to be addressed, and the results of several research studies addressing MCC.
• Maciejewski and Bayliss5 suggest that quasiexperimental designs using large databases will be the workhorse design of the MCC field.
• Importantly, they showed that patients with the most common combinations of conditions (eg, diabetes, hyperlipidemia, and hypertension) are not the most costly.
• The authors conclude that patient and provider beliefs and preferences weigh heavily in statin prescribing decisions.
• In a sample of Veterans Administration (VA) patients with depression, some comorbidities (eg, cardio/cerebrovascular disease, peptic ulcer/GERD, or arthritis) increased the likelihood of receiving guideline-concordant care, whereas others (eg, substance or alcohol abuse) decreased the likelihood of receiving guideline-concordant care.16 Similarly, Domino et al17 showed that cancer screening and quality measures for single disease were generally lower among persons with MCC who also had mental illness, compared with those without mental illness.

Why it matters

This issue of Medical Care includes a theoretical framework for research on multiple chronic conditions and results of several studies addressing MCC. It notes that patients with the most common combinations of conditions are not the most costly, and that cancer screening and quality measures for single disease were generally lower among persons with MCC who also had mental illness.

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Study details

• Study designlongitudinal study
• Participants110,000
• Effect size34.5%
• Evidence strengthHigh

Read the original

• DOI: 10.1097/mlr.0000000000000093
• PubMed: 24561755
• Original source →

May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.

@article{tinetti2014-24561755,
  author  = {Tinetti, Mary E. and Basu, Jayasree},
  title   = {{Research on Multiple Chronic Conditions}},
  journal = {Medical Care},
  year    = {2014},
  doi     = {10.1097/mlr.0000000000000093},
  pmid    = {24561755},
  url     = {https://doi.org/10.1097/mlr.0000000000000093}
}

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