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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 3/2014

01-03-2014 | Review Article

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

Authors: Donna M. Zulman, MD, MS, Steven M. Asch, MD, MPH, Susana B. Martins, MD, MSc, Eve A. Kerr, MD, MPH, Brian B. Hoffman, MD, Mary K. Goldstein, MD, MS

Published in: Journal of General Internal Medicine | Issue 3/2014

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ABSTRACT

Multimorbidity—the presence of multiple chronic conditions in a patient—has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient’s number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions.
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Metadata
Title
Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness
Authors
Donna M. Zulman, MD, MS
Steven M. Asch, MD, MPH
Susana B. Martins, MD, MSc
Eve A. Kerr, MD, MPH
Brian B. Hoffman, MD
Mary K. Goldstein, MD, MS
Publication date
01-03-2014
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 3/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-013-2616-9

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