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Identifying key outcomes for multimorbidity research

By Susan M Smith, Emma Wallace, Chris Salisbury, Maxime Sasseville, Elizabeth Bayliss, Martin Fortin
A new study has identified the most appropriate outcomes to assess in studies examining interventions for patients who suffer from multiple chronic medical conditions (multimorbidity). It has been conducted by researchers from RCSI (Royal College of Surgeons in Ireland). The study was carried out by the Health Research Board (HRB) Centre for Primary Care Research at RCSI’s Department of General Practice in collaboration with researchers from the University of Bristol, in the United Kingdom, the University of Sherbrooke in Canada and the University of Colorado din the USA . The study was published in the leading US primary care journal, the Annals of Family Medicine [1].
Multimorbidity is present in a patient when the individual has two or more chronic medical conditions. These patients are more likely to experience decreased quality of life, functional decline and increased need for healthcare. They often need to take several medications (polypharmacy) and can experience fragmented care due to involvement with multiple healthcare providers. There is growing interest in trying to identify effective interventions that can improve outcomes for patients with multimorbidity. We conducted a study to identify which outcomes should be prioritised in these studies. We used a Delphi consensus process involving 26 researchers, clinicians and patients from 13 countries.
This panel of international experts agreed that clinical trials of multimorbidity should measure and report, at minimum, quality of life, mortality, and mental health outcomes. The panel reached consensus on 17 core outcomes for multimorbidity research in total. The highest ranked outcomes were health-related quality of life, mental health outcomes and mortality. Other outcomes were grouped into overarching themes of patient-reported impacts and behaviors (treatment burden, self-rated health, self-management behavior, self-efficacy, adherence); physical activity and function (activities of daily living, physical function, physical activity); outcomes related to the medical visit (communication, shared decision-making, prioritization); and health systems outcomes (healthcare utilization, costs, quality of healthcare). The authors suggest that, when designing studies to capture important domains in multimorbidity, researchers consider the full range of outcomes based on study aims and interventions.
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1. Smith SM, Wallace E, Salisbury C, et al. A Core Outcome Set for Multimorbidity Research (COSmm). Ann Fam Med 2018;16(2):132-38.

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