Clinical Practice Guidelines and Quality of Care for Older Patients With Multiple Comorbid Diseases

Abstract

This review suggests that adhering to current CPGs in caring for an older person with several comorbidities may have undesirable effects. Basing standards for quality of care and pay for performance on existing CPGs could lead to inappropriate judgment of the care provided to older individuals with complex comorbidities and could create perverse incentives that emphasize the wrong aspects of care for this population and diminish the quality of their care. Developing measures of the quality of the care needed by older patients with complex comorbidities is critical to improving their care.

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions

“…Developing applications that synthesize information about multiple conditions and discuss potential interactions and conflicting recommendations is clearly a challenging task, one that is further complicated by a shortage of evidence about treatment in the setting of MCCs. 1,8,[39][40][41][42][43] In addition, insurers, employers, and other payers may be hesitant to reimburse eHealth technology until the effectiveness (and costeffectiveness) of these tools has been established. 44 While many patients currently purchase personal devices and technology, this will not cover the cost of developing and maintaining technology that integrates electronic health record data and facilitates information exchange among health care systems.…”

“…For example, patients with MCCs frequently face unwieldy medication regimens and daily self-care routines that may reduce adherence to recommended treatment plans. [4][5][6][7][8] They also often need to track and coordinate health information from different health care providers 9 and monitor and distinguish between symptoms from different diseases. [10][11][12] As a result, there is a great need for effective tools to support the self-care activities associated with multiple health issues.…”

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

“…42,43 Additional challenges arise when patients have several clinicians involved in their care, increasing the likelihood of conflicting advice, redundant diagnostic tests and services, and impractical treatment regimens. 1,44 Finally, it should be noted that in some instances, traditional quality measures may not represent appropriate goals for patients with multiple chronic conditions. 44 Few quality measures account for these circumstances, however, making it difficult to interpret aggregate quality scores for heterogeneous populations.…”

“…1,44 Finally, it should be noted that in some instances, traditional quality measures may not represent appropriate goals for patients with multiple chronic conditions. 44 Few quality measures account for these circumstances, however, making it difficult to interpret aggregate quality scores for heterogeneous populations.…”

“…In order for a treatment plan to be adherent to all relevant guidelines, the patient's regimen would need to include 12 medications and 14 non-pharmacologic therapies, setting the stage for several possible drug-condition, drug-drug, and food-drug interactions. 44 Qualitative studies with providers have exposed additional challenges generated by interrelated comorbidities. 54 In one study in the U.K., providers noted that problems arise when clinical options for managing one condition are limited by the presence of another condition, 55 as occurs when a patient would benefit from cardiovascular exercise, but is limited in the type of exercise due to osteoarthritis or obstructive pulmonary disease, or when dietary recommendations for two conditions conflict (as occurs with protein recommendations for diabetes and gout).…”