Entete 3

Multimorbidity measures

By Alyson Huntley

In the Academic Unit of Primary Health Care at the University of Bristol, one of our key research themes is organisation and delivery of care led by Professor Chris Salisbury.  This theme relates to providing evidence about the impact of changes in how primary health care is organised and delivered. Our research often combines quantitative, qualitative and economic methods. We have conducted a number of large scale multi-centre evaluations of important initiatives. We are particularly interested in the impact of these new models of care on core values of primary care such as access to care, generalism, co-ordination and continuity of care.

An important part of this research is the study of multimorbidity. We have several projects running in this area at the moment including:

  • The impact of multimorbidity on the use of resources in primary care
  • Complex consultations. The impact of multimorbidity on consultations.
  • A systematic review of measures of multimorbidity.

We have recently published the systematic review on multimorbidity measures in the Annals of Family Medicine (Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. 2012;10(2):134-41).

The aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and community populations, and to investigate their validity in relation to anticipated associations with patient characteristics, process measures, and health outcomes.

We found that the measures most commonly used in primary care and community settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.

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