Multimorbidity Is Associated with Better Quality of Care Among Vulnerable Elders

Published in: Medical Care, v. 45, no. 6, June 2007, p. 480-488

Posted on RAND.org on December 31, 2006

by Lillian Min, Neil S. Wenger, Constance Fung, John T. Chang, David A. Ganz, Takahiro Higashi, Caren Kamberg, Catherine MacLean, Carol P. Roth, David Solomon, Roy Young, David Reuben

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BACKGROUND: Older patients with multiple chronic conditions may be at higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions. Possible reasons include competing guidelines for individual conditions, burden of numerous recommendations, and difficulty implementing treatments for multiple conditions. OBJECTIVES: The authors sought to determine whether coexisting combinations of 8 common chronic conditions (hypertension, coronary artery disease, chronic obstructive pulmonary disease, osteoarthritis, diabetes mellitus, depression, osteoporosis, and having atrial fibrillation or congestive heart failure) are associated with overall quality of care among vulnerable older patients. MATERIALS AND METHODS: Using an observational cohort study, the authors enrolled 372 community-dwelling persons 65 years of age or older who were at increased risk for death or functional decline within 2 years. The authors included (1) a comprehensive measure (% of quality indicators satisfied) of quality of medical and geriatric care that accounted for patient preference and appropriateness in light of limited life expectancy and advanced dementia, and (2) a measure of multimorbidity, either as a simple count of conditions or as a combination of specific conditions. RESULTS: Multimorbidity was associated with greaer overall quality scores: mean proportion of quality indicators satisfied increased from 47% for elders with none of the prespecified conditions to 59% for those with 5 or 6 conditions (P < 0.0001), after controlling for number of office visits. Patients with greater multimorbidity also received care that was better than would be expected based on the specific set of quality indicators they triggered. CONCLUSIONS: Among older persons at increased risk of death or functional decline, multimorbidity results in better, rather than worse, quality of care.

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