AHRQ UPDATES ON PRIMARY CARE RESEARCH: MULTIPLE CHRONIC CONDITIONS RESEARCH NETWORK

Almost one-third of all Americans—and 80% of older Americans—are estimated to have at least 2 or more concurrent chronic conditions that collectively have an adverse effect on health status, function, or quality of life, and that require complex approaches to health care.^1,2 Treatment for people living with multiple chronic conditions (MCC) accounts for an estimated 71%¹ of the Nation’s health care costs, and 93% of Medicare expenditures.³ The number of people with MCC is growing, and is expected to continue to grow as the population ages. However, relatively little is known about how to best treat these patients. Most medical research remains focused on single conditions, and clinical care guidelines rarely address comorbid conditions. Adherence to multiple guidelines that each focus on a single condition is often impractical for patients, and treatment for one condition can have negative effects on other conditions. To make matters worse, clinicians are often compensated based on disease-specific performance measures, which may encourage unnecessary, and even potentially harmful, care for patients with MCC.

The Agency for Healthcare Research and Quality (AHRQ) is working to build the evidence base to support better care for people with MCC in support of the Department of Health and Human Services’ national Strategic Framework on Multiple Chronic Conditions.⁴ In particular, AHRQ’s Improving Primary Care initiative aims to improve health outcomes and quality of life for people with MCC by improving the quality, safety, efficiency, and effectiveness of evidence-based preventive and chronic care services. As part of this effort, AHRQ funded the Multiple Chronic Conditions Research Network to help advance the field of MCC research, provide needed guidance for clinicians and patients, and advise policymakers about improved methods to measure and promote quality care for patients with complex multiple conditions. In addition, AHRQ’s Improving Primary Care Initiative currently sponsors a number of initiatives related to improving care for patients with MCC, including work on: care coordination, team-based care, self-management support, clinical decision support, integration of behavioral/mental health with primary care, clinical-community linkages, health information technology integration, and healthcare/system redesign.

The AHRQ MCC Research Network comprises 18 pioneer grant projects funded in 2008, and an additional 27 grant studies funded in 2010 through the American Recovery and Reinvestment Act (ARRA). Each of the 2008-funded studies focused on the use of preventive services for patients with MCC to improve understanding about which interventions provide the greatest benefit to people with MCC. The 2010 funded grants focused on exploratory research or infrastructure development to address comparative effectiveness research to optimize prevention and healthcare management for the complex patient. Roughly one-half of the 2010 funded grants used existing, or easily developed, data sources to help prioritize testing and treatments for patients with MCC, and to suggest appropriate adaptations to recommended care guidelines. The remaining investigators developed new datasets or other infrastructure to fill a void in research on MCC and conducted pilot studies to demonstrate the use of the new infrastructure. They also worked to make these new data sets publically accessible to other researchers. AHRQ also funded a Technical Assistance Center (TAC) to support the work of the MCC Research Network by facilitating information sharing and collaboration across the Network investigators. The TAC is staffed by Abt Associates, the MacColl Center for Healthcare Innovation, and the Inter-University Consortium for Political and Social Research (ICPSR).

• © 2013 Annals of Family Medicine, Inc.