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The Article in Brief
Measures of Multimorbidity and Morbidity Burden for Use in Primary Care and Community Settings: A Systematic Review and Guide
Chris Salisbury , and colleagues
Background Many primary care patients have multiple medical conditions (multimorbidity). To assess the impact of muilitmorbidity, it is necessary to measure it. This analysis of existing research identifies measures of multimorbidity and morbidity (illness) burden suitable for use in research in primary care and community populations and investigates their validity.
What This Study Found This systematic review identifies 17 different measures. The measures most commonly used in primary care, and for which there is greatest evidence of validity, are disease counts, the Charlson index, and the Adjusted Clinical Groups (ACG) System. Different measures are most appropriate according to the outcome being studied and the type of data available. For example, researchers interested in the relationship between multimorbidity and health care utilization will find most evidence for the validity of the Charlson Index, the ACG System and disease counts, but evidence is strongest for the ACG System in relation to costs, for Charlson index in relation to mortality, and for disease counts or Charlson index in relation to quality of life. Other measures, such as the Cumulative Index Illness Rating Scale and Duke Severity of Illness Checklist, are more complex to administer and their advantages over easier methods have not been well established.
Implications
- Research is needed to directly compare the performance of different measures.
Supplemental Appendix, Tables, & Figure
Supplemental Appendix. Multimorbidity in the Primary Care Setting Search Strategy; Supplemental Table 1. Index of Studies With Demonstrated Associations Between Patient Sociodemographic Characteristics and Multimorbidity or Morbidity Burden Using Different Measures; Supplemental Table 2. Index of Studies Which Have Demonstrated Relationships Between Multimorbidity or Morbidity Burden and Cost or Process of Care Using Different Measures; Supplemental Table 3. Index of Studies Which Have Demonstrated Relationships Between Multimorbidity or Morbidity Burden and Patient Health Outcomes Using Different Measures; Supplemental Figure 1. PRISMA diagram
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 2 pages
- Supplemental data: Tables 1-3 - PDF file, 10 pages
- Supplemental data: Figure - PDF file, 1 page