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Monthly Archives: October 2013

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.