Public Health

AHRQ’s research agenda for tackling patients with multiple chronic conditions

Bierman et al. (2021) defines multiple chronic conditions (MCC) are as “the co-occurrence of two or more chronic physical or mental health conditions”. Why do policymakers, payers and clinicians care so much about patients with MCC?

One in three American adults, four in five Medicare beneficiaries, and a growing number of children have MCC. People living with MCC account for a disproportionate share of health care utilization and costs, 64% of all clinician visits, 70% of all inpatient stays, 83% of all prescriptions, 71% of all health care spending, and 93% of Medicare spending…Nearly all readmissions among Medicare beneficiaries occur among those with MCC. The prevalence of MCC will grow with our aging population.

One key challenge in preventing and treating MCC is that most interventions are focused on a specific disease, whereas many patients with MCC face multiple diseases simultaneously. Some may say, “why don’t we have more research on patients with MCC. One of the challenges is that while MCCs are common, each specific combination of diseases patients with MCC may have a relatively small population and treatment for one MCC patient (say one with diabetes and heart failure) typically cannot be extrapolated to another MCC patient (say one with COPD and Alzheimer’s).

The Bierman paper provides some additional information on MCC patients:

  • COVID-19. 88% of individuals hospitalized with SARS-CoV-2 infection had MCC.
  • Health disparities. Racial/ethnic minorities and those who are socioeconomically disadvantaged are more likely to: (i) develop MCC at earlier ages, (ii) have more conditions, (iii) each condition is likely to be of greater severity, and (iv) the net impact on patient health will lead to more functional limitations.

The Agency for Healthcare Research and Quality (AHRQ) wants to improve care for patients with MCC. In the Bierman article, they aim to do this by answering the following questions as part of their research agenda:

  • How can care become more patient centered for patients with MCC? This includes better approaches to measuring quality, better health IT, and integrating social, behavioral and economic factors into the care plan.
  • How can the patient centered medical home be improved for patients with MCC? This includes better care coordination as well as risk stratification.
  • How can the health care system use technology to better reach MCC patients? These initiatives include telehealth, remote monitoring, and other technologies.
  • How can the health care system improve health equity? These initiatives include improving access, as well as partnering with individuals and communities to tailor interventions to the disadvantaged.
  • How can the health care system reduce the burden on patients, caregivers and clinicians? This includes reducing monitoring burden, administrative costs, reduce caregiver and clinician burnout, as well as incentivizing the use of high-value care.
  • How can the identified methods be translated into daily practice? Many studies will identify an ideal practice in one single clinic or within a single patient population. However, more research is needed to determine how to translate interventions that would improve care for patients with MCC into real-world, high-value applications.

AHRQ’s research agenda is an ambitious one. Improving quality of care for patients with MCC is vital. However, this research agenda faces a key challenge: reaching broad conclusions may mean that a specific intervention may not be very relevant for patients with MCC with a specific combination of chronic conditions; on the other hand, focusing on specific chronic conditions combinations is challenging just because there are so many chronic condition combinations and the sample size of any one MCC chronic condition combination is likely to be small. If, however, AHRQ is able to find broad interventions that improve care across all or most MCC patients, that would be a significant advance.

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