Bierman et al. (2021) defines multiple chronic conditions (MCCs) as “the co-occurrence of two or more chronic physical or mental health conditions”. Why do politicians, payers and doctors care so much about MCC patients?
One in three American adults, four in five Medicare beneficiaries, and an increasing number of children have MCC. People living with MCC account for a disproportionate share of healthcare usage and costs, 64% of all doctor visits, 70% of all hospital admissions, 83% of all prescriptions, 71 % of all health care spending and 93% of Medicare spending … Almost all readmissions among Medicare beneficiaries occur among those with MCC. The prevalence of CCM will increase as the population ages.
A key challenge in the prevention and treatment of MCC is that most interventions focus on a specific disease, while many patients with MCC face multiple diseases at the same time. Some may say, “because we no longer have research on MCC patients. One of the challenges is that while MCCs are common, each specific disease combination of MCC patients may have a relatively small population and the treatment for an MCC patient (say one with diabetes and heart failure) typically cannot be extrapolated to another patient with MCC (say one with COPD and Alzheimer’s).
Bierman’s paper provides some additional information on MCC patients:
- COVID-19. 88% of people admitted to hospital with SARS-CoV-2 infection had MCC.
- Inequality of health. Racial / ethnic minorities and those who are socioeconomically disadvantaged are more likely to: (i) develop CCM at an early age, (ii) have multiple conditions, (iii) each condition is likely to be more severe, and (iv) the network impact on the patient’s health will lead to greater functional limitations.
The Agency for Health Research and Quality (AHRQ) wants to improve care for patients with MCC. In Bierman’s article, they aim to do this by answering the following questions as part of their research program:
- How can care become more patient-centered for patients with MCC? This includes better approaches to measuring quality, better health informatics, and the integration of 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 coordination of care and risk stratification.
- How can the healthcare system use technology to better reach MCC patients? These initiatives include telemedicine, remote monitoring and other technologies.
- How can the health system improve health equity? These initiatives include improving access, as well as working with individuals and communities to tailor interventions to disadvantaged people.
- How can the healthcare system reduce the burden on patients, healthcare professionals and doctors? This includes reducing the monitoring burden, administrative costs, reducing the burnout of healthcare professionals and doctors, as well as encouraging the use of high-value care.
- How can the identified methods be translated into daily practice? Many studies will identify an ideal practice in a 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, high-value applications.
AHRQ’s research agenda is ambitious. It is essential to improve the quality of care for patients with MCC. However, this research agenda addresses a key challenge: reaching general conclusions may mean that a specific intervention may not be very relevant for MCC patients with a specific combination of chronic conditions; on the other hand, focusing on specific combinations of chronic conditions is challenging just because there are so many combinations of chronic conditions and the sample size of any combination of chronic conditions of MCC is likely to be small. If, however, AHRQ is able to find broad interventions that improve care in all or most MCC patients, it would be a significant advance.