Challenges for Patients With Multiple Chronic Health Conditions

Millions of Americans live with more than one chronic health disease, and they are at a higher risk of poor health outcomes and have a disproportionate share of health care costs. A special March supplement to Medical Care presents updates from the Agency for Healthcare Research and Quality's (AHRQ) Multiple Chronic Conditions (MCC) Research Network, formed to address knowledge gaps and research challenges in meeting the complex health care needs of this growing population. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. Meeting the Needs of People with MCC—More Than Just a "Collection of Diseases"The March special supplement, titled Advancing the Field: Results from the AHRQ Multiple Chronic Conditions Research Network, presents research and commentaries based on grants funded by AHRQ to improve understanding about how to best care for the growing number of people living with multiple chronic conditions (MCC). The AHRQ MCC Research Network supports the U.S. Department of Health & Human Services' (HHS) Multiple Chronic Conditions Strategic Framework and the HHS Initiative on Multiple Chronic Conditions, a public-private sector partnership to address the needs of people living with MCC and the health systems that serve them. The special issue can be accessed on the Medical Care website.

"This special issue presents important evidence that can help to ensure safe and high quality health care for the growing number of people who live with more than one ongoing condition," commented AHRQ Director Richard Kronick, PhD.

It is estimated that more than one-fourth of all Americans, and two-thirds of older adults, are living with MCC— defined as two or more chronic physical or behavioral health problems. Care for patients with MCC accounts for an estimated two-thirds of the nation's nearly $3 trillion in total health care spending. As the US population ages, the number of people with MCC is increasing steadily—by 2030, there are expected to be more than 170 million Americans living with at least one chronic condition.

The special issue "captures the state of research on MCC and serves as a model for future research in the field," according to an introductory editorial by Guest Editors Mary E. Tinetti, MD, of Yale University and Jayasree Basu, PhD, MBA, of AHRQ.

In their overview paper, David Grembowski, PhD and colleagues highlight the need for a new conceptual approach to MCC. They believe the focus on single conditions needs to be replaced by a model accounting for the "inherent complexity" presented by the mismatch between patients' needs and the current structure of the health care system.

Similarly, Lisa LeRoy, PhD and coauthors emphasize that caring for patients with MCC involves more than treatment of a "collection of diseases." They call for a focus on "holistic outcomes in humans who live meaningful lives in relationship with family and community."

Research Highlights Importance of Behavioral Health IssuesThe supplement includes 12 original research papers, reflecting the range of difficult questions requiring evidence to improve the care of patients with MCC. Topics include the conditions adding the most to the costs of MCC, sources of "unexplained and potentially unwarranted variations" in treatment for patients with MCC, and the appropriateness of current treatment guidelines for patients with MCC.

A recurring issue is the contribution of behavioral health problems, often coexisting with physical health problems. Patients with concurrent behavioral health issues may be "particularly vulnerable" to the problems associated with MCC.

But MCC research poses difficult challenges—a "one-size fits all" approach can't capture the various combinations of conditions and contributing factors seen in patients with MCC. Drs Tinetti and Basu identify priorities for MCC research, including further development of research methods, and improvement of treatment guidelines and of the health care system's ability to meet the needs of patients with MCC.

Highlights from the special issue will be presented in a webinar on Tuesday, February 25, 2014, at 3:00 pm EST. Three researchers from the AHRQ MCC Research Network will discuss topics including the role of clinical practice guidelines in managing patients with MCC, use of the "medical homes" in caring for patients with concurrent physical and mental illness, and approaches to addressing the fragmentation of hospital care for MCC patients.



Source-Eurekalert