Article Figures & Data
Figures
- Figure 1
Overview of the Delphi process used to develop the core outcome set for multimorbidity research (COSmm).
IQR = interquartile range.
Tables
Outcome Panelists Scoring, No. Score, Median (IQR)a Included Health-related quality of life 25 5 (4–5) Mental health 25 5 (4–5) Mortality 26 4.5 (4–5) Activities of daily living 25 4 (4–5) Physical function 23 4 (4–5) Self-rated health 25 4 (4–5) Treatment burden 25 4 (4–5) Communication 25 4 (4–5) Health care use 24 4 (4–5) Costs 24 4 (4–5) Adherence 24 4 (4–4) Excluded: none – – IQR=interquartile range.
↵a Panelists were asked whether the outcome should be included in the multimorbidity core outcome set. Response options on a 5-point Likert scale ranged from 1 = strongly disagree to 5 = strongly agree.
Panelists Scoring, No. Score, Median (IQR)a Outcome Round 1 Round 2 Round 1 Round 2 Included Shared decision making 25 26 4 (3–5) 4 (4–5) Quality health care 24 26 4 (3–5) 4 (4–5) Prioritization 24 26 4 (3–4.5) 4 (4–5) Self-management behavior 25 26 4 (3–4) 4 (4–4) Self-efficacy 25 26 4 (3–4) 4 (4–4) Physical activity 24 26 4 (3–4) 4 (4–5) Excluded (no agreement) Generic symptom measures 25 26 4 (3–4) 4 (3–4) Social role 25 26 4 (3–4) 4 (3–4) Social support 25 26 4 (3–4) 4 (3–4) Patient enablement 25 26 4 (3–5) 4 (3–4) System factors (continuity) 23 26 4 (3–4) 4 (3–4) Treatment satisfaction 24 26 4 (3–4) 4 (3–4) Social inclusion 25 26 4 (2–4) 4 (3–4) Smoking 21 26 3.5 (2–4) 3 (3–4) Alcohol 22 26 3.5 (2–4) 3 (3–4) Nutrition 24 26 3.5 (2–4) 3 (3–4) Obesity 26 26 3 (2–4) 3 (2–4) Illness perceptions 23 26 3 (2–4) 3 (3–4) Self-esteem 25 26 3 (2–4) 3 (3–4) IQR=interquartile range.
↵a Panelists were asked whether the outcome should be included in the multimorbidity core outcome set. Response options on a 5-point Likert scale ranged from 1 = strongly disagree to 5 = strongly agree.
Highest-scoring outcomes Health-related quality of life Mental health Mortality Patient-reported impacts and behaviors Treatment burden Self-rated health Self-management behavior Self-efficacy Adherence Physical activity and function Activities of daily living Physical function Physical activity Consultation related Communication Shared decision making Prioritization Health systems Health care use Costs Quality health care (patient-rated)
Supplemental Appendixes
Supplemental Appendixes
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The Article in Brief
A Core Outcome Set for Multimorbidity Research (COSmm)
Susan M. Smith , and colleagues
Background Core outcome sets represent the minimum that should be measured and reported in a clinical trial of a specific condition. In this study, an international panel of experts established a core outcome set for research of multimorbidity (two or more chronic conditions in an individual).
What This Study Found Clinical trials of multimorbidity should measure and report, at minimum, quality of life, mortality, and mental health outcomes. Twenty-six multimorbidity researchers, clinicians, and patients from 13 countries participated in a Delphi Panel and reached consensus on 17 core outcomes for multimorbidity research. The highest ranked outcomes were health related quality of life, mental health outcomes and mortality. Other outcomes were grouped into overarching themes of patient-reported impacts and behaviors (treatment burden, self-rated health, self-management behavior, self-efficacy, adherence); physical activity and function (activities of daily living, physical function, physical activity); outcomes related to the medical visit (communication, shared decision making, prioritization); and health systems outcomes (healthcare utilization, costs, quality of health care).
Implications
- The authors suggest that, when designing studies to capture important domains in multimorbidity, researchers consider the full range of outcomes based on study aims and interventions.
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