Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions

Mayra Tisminetzky; Elizabeth A Bayliss; Jay S Magaziner; Heather G Allore; Kathryn Anzuoni; Cynthia M Boyd; Thomas M Gill; Alan S Go; Susan L Greenspan; Leah R Hanson; Mark C Hornbrook; Dalane W Kitzman; Eric B Larson; Mary D Naylor; Benjamin E Shirley; Ming Tai-Seale; Linda Teri; Mary E Tinetti; Heather E Whitson; Jerry H Gurwitz

doi:10.1111/jgs.14943

Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions

J Am Geriatr Soc. 2017 Jul;65(7):1549-1553. doi: 10.1111/jgs.14943. Epub 2017 May 26.

Authors

Mayra Tisminetzky^{1

2}, Elizabeth A Bayliss^{3

4}, Jay S Magaziner⁵, Heather G Allore⁶, Kathryn Anzuoni¹, Cynthia M Boyd⁷, Thomas M Gill⁶, Alan S Go⁸, Susan L Greenspan⁹, Leah R Hanson¹⁰, Mark C Hornbrook¹¹, Dalane W Kitzman¹², Eric B Larson¹³, Mary D Naylor¹⁴, Benjamin E Shirley¹⁵, Ming Tai-Seale¹⁶, Linda Teri¹⁷, Mary E Tinetti⁶, Heather E Whitson^{18

19}, Jerry H Gurwitz^{1

2}

Affiliations

¹ Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.
² Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
³ Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
⁴ Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado.
⁵ Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
⁶ School of Medicine, Yale University, New Haven, Connecticut.
⁷ Division of Geriatric Medicine, Johns Hopkins University, Baltimore, Maryland.
⁸ Division of Research, Kaiser Permanente Northern California, Oakland, California.
⁹ New Courtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁰ HealthPartners Institute, Minneapolis, Minnesota.
¹¹ Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
¹² Wake Forest Baptist Medical Center, Winston Salem, North Carolina.
¹³ Kaiser Washington Health Research Institute, Seattle, Washington.
¹⁴ School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁵ Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
¹⁶ Palo Alto Medical Foundation Research Institute, Palo Alto, California.
¹⁷ School of Nursing, University of Washington, Seattle, Washington.
¹⁸ Duke University Aging Center, Duke University, Durham, North Carolina.
¹⁹ Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.

Abstract

Objectives: To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs).

Design: Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs.

Setting: Survey conducted through the Health Care Systems Research Network (HCSRN) and Claude D. Pepper Older Americans Independence Centers (OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs.

Participants: Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios.

Measurements: A "top box" methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics.

Results: The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making.

Conclusion: Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this "high-need, high-cost" population and the healthcare delivery systems responsible for serving it.

Keywords: aging; geriatrics; multimorbidity; multiple chronic conditions.

MeSH terms

Caregivers
Chronic Disease*
Delivery of Health Care*
Drug Interactions
Health Services Research
Humans
Multiple Chronic Conditions / therapy*
Outcome and Process Assessment, Health Care
Quality of Life / psychology
Research*
Surveys and Questionnaires

Abstract

MeSH terms

Grants and funding