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Author Archives: Donna Zulman

How can eHealth technology address challenges related to multimorbidity?

By Donna Zulman

Patients with multiple chronic conditions (MCCs) face substantial self-management challenges related to having multiple health issues. For example, patients with MCCs frequently face unwieldy medication regimens and daily self-care routines that may reduce adherence to recommended treatment plans. They also often need to track and coordinate health information from different health care providers and monitor and distinguish between symptoms from different diseases. As a result, there is a great need for effective tools to support the self-care activities associated with multimorbidity. Patient-facing “eHealth” technology may provide opportunities to address these patients’ needs.

We conducted a qualitative study [1] (published in the Journal of General Internal Medicine) with patients with MCCs to explore their self-management and health care navigation challenges, and to identify opportunities to support these patients through new and enhanced eHealth technology. Three themes emerged to guide eHealth technology development: (1) Patients with MCCs manage a high volume of information, visits, and self-care tasks; (2) they need to coordinate, synthesize, and reconcile health information from multiple providers and about different conditions; and (3) their unique position at the hub of multiple health issues requires self-advocacy and expertise. Focus groups identified desirable eHealth resources and tools that reflect these themes.

The abstract of the article can be found at http://www.ncbi.nlm.nih.gov/pubmed/25691239

1) Zulman DM, Jenchura EC, Cohen DM, Lewis ET, Houston TK, Asch SM. How can eHealth technology address challenges related to multimorbidity? Perspectives from patients with multiple chronic conditions. J Gen Intern Med. 2015 [Epub ahead of print]).

Incorporating comorbidity interrelatedness into clinical practice, research, and policy

By Donna Zulman

Multimorbidity is an increasingly recognized challenge to quality improvement and cost-containment efforts for healthcare systems. In order to optimize interventions and policies addressing multimorbidity, we must have a clear understanding of the relationship between multimorbidity and quality of care. In a recent article in the Journal of General Internal Medicine [1], we review the literature on multimorbidity and quality of care, the majority of which has focused on how clinical care is affected by a patient’s number of chronic conditions and specific characteristics of those conditions (e.g. symptom intensity, clinical dominance). We suggest that quality of care for patients with multiple chronic conditions is also likely influenced by comorbidity interrelatedness, or the degree to which conditions interact to affect clinical management.
 While comorbidity interrelatedness is a familiar concept to many clinicians, there is a need to more formally integrate this construct into research, clinical support tools, and quality metrics. In our article, we introduce a framework for multimorbidity that incorporates comorbidity interrelatedness, as well as traditional concepts of comorbidity count and characteristics. We describe how each of these constructs can generate clinical complexity and influence quality of care. Finally, we provide recommendations for operationalizing the concept of comorbidity interrelatedness, and incorporating this construct into clinical practice, research, guideline development, and performance metrics and reimbursement.
[1] Zulman DM, Asch SM, Martins SB, Kerr EA, Hoffman BB, Goldstein MK. Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness. J Gen Intern Med. Oct 1 2013.