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Monthly Archives: October 2011

Multimorbidity Publications June – September 2011

By Martin Fortin

New papers on multimorbidity have been published during the June-September period of this year. I would like to share with you the titles of the most relevant articles published, along with the links to the abstracts or full texts:

1.    Findley, P., C. Shen, and U. Sambamoorthi, Multimorbidity and persistent depression among veterans with diabetes, heart disease, and hypertension. Health Soc Work, 2011. 36: p. 109-19. [PubMed abstract]
2.    Fried, T.R., et al., Health Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions. Arch Intern Med. Sep 26. [Epub ahead of print], 2011. [Research letter; no abstract available]
3.    Gulley, S.P., E.K. Rasch, and L. Chan, The complex web of health: relationships among chronic conditions, disability, and health services. Public Health Rep, 2011. 126: p. 495-507. [PubMed abstract]
4.    Harrison, M., et al., A secondary analysis of the moderating effects of depression and multimorbidity on the effectiveness of a chronic disease self-management programme. Patient Educ Couns. Jul 16. [Epub ahead of print], 2011. [PubMed abstract]
5.    Holden, L., et al., Patterns of multimorbidity in working Australians. Popul Health Metr, 2011. 9: p. 15. [Full text]
6.    Hunger, M., et al., Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health Qual Life Outcomes, 2011. 9: p. 53. [Full text]
7.    Khanam, M.A., et al., Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study. J Health Popul Nutr, 2011. 29: p. 406-14. [Full text]
8.    Lehnert, T., et al., Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev, 2011. 68: p. 387-420. [PubMed abstract]
9.    Parekh, A.K., et al., Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep, 2011. 126: p. 460-71. [PubMed abstract]
10.    Perruccio, A.V., J.N. Katz, and E. Losina, Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone. J Clin Epidemiol. Aug 9. [Epub ahead of print], 2011. [PubMed abstract]
11.    Quiñones, A.R., et al., How Does the Trajectory of Multimorbidity Vary Across Black, White, and Mexican Americans in Middle and Old Age? J Gerontol B Psychol Sci Soc Sci. Oct 3. [Epub ahead of print], 2011. [PubMed abstract]
12.    Richardson, K., et al., Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging, 2011. 28: p.:547-60. [PubMed abstract]
13.    Starfield, B. and K. Kinder, Multimorbidity and its measurement. Health Policy. Sep 30. [Epub ahead of print], 2011. [PubMed abstract]
14.    Tinetti, M.E., et al., Contribution of Multiple Chronic Conditions to Universal Health Outcomes. J Am Geriatr Soc. Aug 30. [Epub ahead of print], 2011. [PubMed abstract]
15.    Tinetti, M.E. and S.A. Studenski, Comparative effectiveness research and patients with multiple chronic conditions. N Engl J Med, 2011. 364(26): p. 2478-81. [Full text]
16.    van Baal, P.H., et al., Co-occurrence of diabetes, myocardial infarction, stroke, and cancer: quantifying age patterns in the Dutch population using health survey data. Popul Health Metr, 2011. 9: p. 51. [Full text]
17.    van den Bussche, H., et al., Patterns of ambulatory medical care utilization in elderly patients with special reference to chronic diseases and multimorbidity – Results from a claims data based observational study in Germany. BMC Geriatrics, 2011. 11: p. 54. [Full text]
18.    Vyas, A. and U. Sambamoorthi, Multimorbidity and depression treatment. Gen Hosp Psychiatry, 2011. 33: p. 238-45. [PubMed abstract]

Publication number 15 on the list is an article by Mary E. Tinetti and Stephanie A. Studenski published in the ‘Perspective’ section of the New England Journal of Medicine. I would like to bring to your attention its most important statements in my opinion:

“Primary outcomes tend to be disease-specific… Such outcomes work well in efficacy studies, which reveal a therapy’s effect on a specific outcome under ideal circumstances in a homogeneous population. They make less sense, however, for comparing treatments in patients with multiple chronic conditions.”

“Researchers have largely shied away from the complexity of multiple chronic conditions — avoidance that results in expensive, potentially harmful care of unclear benefit. We cannot improve health care’s quality, effectiveness, and efficiency without addressing its greatest consumers.”

It is well worth the read.

All references are included in our blog’s library. Feel free to share with anyone interested in multimorbidity.


60-second lecture at AHRQ Grantees conference (9/2011)

By Elizabeth A. Bayliss

In delivering patient-centered care to complex patients, success is measured by achieving health outcomes that matter to patients. 

Historically health outcomes have been disease-specific. These reflect appropriate treatment intensification by clinicians and appropriate adherence to recommendations by patients in order to achieve the best outcomes for a single condition. Goal attainment is facilitated by incentives and protocols that make it relatively easy for both groups to adhere to guidelines. For example, our current investigation suggests that attainment of cholesterol goals in cancer survivors—a protocol-driven outcome—is not associated with cancer stage, but is associated with overall morbidity.  

But which outcomes matter to patients? These often fall into the category of patient-reported outcomes and are increasingly recognized as equally important. Many clinicians are in favor of systematic collection of these outcomes as well. Thanks to extensive validation, we know which measures of patient-reported outcomes are valid, but do we know which outcomes matter? And to whom?

It may be worth pausing before we systematize the collection of patient-reported outcomes in order to check in with patients. We should ask them which health outcomes they consider meaningful, how they would like their clinicians to use this information, and how they would like to have it collected. At that point we will be better prepared to collect –and jointly use– health outcomes relevant to complex patients.