Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Christine Vogeli, PhD1,2, Alexandra E. Shields, PhD1,2, Todd A. Lee, PharmD PhD4,5, Teresa B. Gibson, PhD3, William D. Marder, PhD3, Kevin B. Weiss, MD MPH4,5,and David Blumenthal, MD MPP1,2

1Institute for Health Policy in the Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Thomson Healthcare, Ann Arbor, MI, USA; 4Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 5Center for Complex Chronic Care, Hines VA Hospital, Hines, IL, USA.

Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs.

KEY WORDS: chronic disease; comorbidity; prevalence; quality of health care.

J Gen Intern Med 22(Suppl 3):3915DOI: 10.1007/s11606-007-0322-1 Society of General Internal Medicine 2007

INTRODUCTION

Typically, we study experience with health care conditions, including health care costs and quality, as if these conditions occur in isolation, one at a time. The vast majority of extant clinical guidelines and disease management programs focus on a single condition, although the experience of multiple chronic illnesses is the reality for many patientsparticularly among the elderly and near elderly. The Institute of Medicines report Crossing the Quality Chasm highlights the problem with health system fragmentation and stresses the need for health care systems that promote continuity of care and

integration of services.1 Realigning the focus of health services research to be more in line with the complex experience of patients is central to developing solutions that work. This paper...