comorbidities

In response to the growing populations of people with multiple chronic diseases, new models of care are currently being developed in European countries to better meet the needs of these people. This paper aims to describe the occurrence and characteristics of various types of integrated care practices in European countries that target people with multimorbidity. Data were analysed from multimorbidity care practices participating in the Innovating care for people with multiple chronic conditions (ICARE4EU) project, covering all 28EU Member States, Iceland, Norway and Switzerland...

INTRODUCTION: Adults with multiple (≥2) chronic conditions (MCCs) account for a large portion of US health care costs. Despite the increase in MCC rates with age, most people with MCCs are working age. The study objective was to compare adults with MCCs who were younger than 65 years with those aged 65 years or older on selected measures to better understand the differences between groups and inform interventions that could lower health care costs. METHODS: Data from respondents to the 2015 Behavioral Risk Factor Surveillance System data (N = 201,711) were used to compare adults aged 65 or older with MCCs with those younger than 65 with MCCs in unadjusted and adjusted analyses on chronic conditions, quality of life measures, disability status, access to health care, and modifiable risk factors...

Despite the Affordable Care Act's push to improve the coordination of care for patients with multiple chronic conditions, most measures of coordination quality focus on a specific moment in the care process (e.g., medication errors or transfer between facilities), rather than patient outcomes. One possible supplementary way of measuring the care coordination quality of a facility would be to identify the patients needing the most coordination, and to look at outcomes for that group. This paper lays the groundwork for a new measure of care coordination quality by outlining a conceptual framework that considers the interaction between a patient's interdisciplinarity, biological susceptibility, and procedural intensity...

INTRODUCTION: Older adults living in the community often have multiple, chronic conditions and functional impairments. A challenge for healthcare providers working in the community is the lack of a predictive tool that can be applied to the broad spectrum of mortality risks observed and may be used to inform care planning. OBJECTIVE: To predict survival time for older adults in the home care setting. The final mortality risk algorithm will be implemented as a web-based calculator that can be used by older adults needing care and by their caregivers...

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic disease, being associated with both high rates of morbidity and mortality. Similarly, atrial fibrillation (AF) is associated with a higher risk of both cardiovascular (CV) events and overall mortality. The AF and COPD often coexist, but the impact of COPD on prognosis in European AF patients is unknown. METHODS: We evaluated COPD prevalence in patients enrolled in the EURObservational Research Programme Pilot Survey on Atrial Fibrillation Registry Pilot Phase...

PURPOSE: Timely outpatient follow-up has been promoted as a key strategy to reduce hospital readmissions, though one-half of patients readmitted within 30 days of hospital discharge do not have follow-up before the readmission. Guidance is needed to identify the optimal timing of hospital follow-up for patients with conditions of varying complexity. METHODS: Using North Carolina Medicaid claims data for hospital-discharged patients from April 2012 through March 2013, we constructed variables indicating whether patients received follow-up visits within successive intervals and whether these patients were readmitted within 30 days...

RATIONALE, AIMS AND OBJECTIVES: Develop a risk-stratification model that clusters primary care patients with similar co-morbidities and social determinants and ranks 'within-practice' clusters of complex patients based on likelihood of hospital and emergency department (ED) utilization. METHODS: A retrospective cohort analysis was performed on 10 408 adults who received their primary care at the Medical University of South Carolina University Internal Medicine clinic...

Patients with multiple chronic conditions have been shown to have significant Medicare expenditures. Care coordination programs have been implemented targeting this population by organizations striving to achieve the triple aim of (a) improving healthcare quality, (b) improving the patient experience, and (c) reducing costs. Outcomes of these programs have been mixed. This research brief profiles four published articles that address different aspects of care coordination. Readers are encouraged to access the full articles to learn more details about the intervention strategies and findings described in these articles...

This article examines how older adults experience the physical and social realities of having multiple chronic conditions in later life. Drawing on data from in-depth interviews with 16 men and 19 women aged 73+ who had between three and 14 chronic conditions, we address the following research questions: (a) What is it like to have multiple chronic conditions in later life? (b) How do older men and women 'learn to live' with the physical and social realities of multiple morbidities? (c) How are older adults' experiences of illness influenced by age and gender norms? Our participants experienced their physical symptoms and the concomitant limitations to their activities to be a source of personal disruption...

OBJECTIVE: The 75% of older adults with multiple chronic conditions are at risk of therapeutic competition (i.e. treatment for one condition may adversely affect a coexisting condition). The objective was to determine the prevalence of potential therapeutic competition in community-living older adults. METHODS: Cross-sectional descriptive study of a representative sample of 5,815 community-living adults 65 and older in the U.S, enrolled 2007-2009. The 14 most common chronic conditions treated with at least one medication were ascertained from Medicare claims...

OBJECTIVES: To describe the prevalence and determinants of potentially inappropriate medication (PIM) use and association with hospitalizations in an elderly managed care population in Switzerland. METHODS: Using health care claims data of four health insurers for a sample of managed care patients 65 years of age and older to compare persons on PIM with persons not on PIM. Beers' 2012 and PRISCUS criteria were used to determine the potential inappropriateness of prescribed medications...

The prevalence of multiple chronic conditions (MCC) is increasing, creating challenges for patients, families, and the health care system. A systematic literature search was conducted to locate studies describing patient's perceptions of facilitators and barriers to management of MCC. Thirteen articles met study inclusion criteria. Patients reported nine categories of barriers including financial constraints, logistical challenges, physical limitations, lifestyle changes, emotional impact, inadequate family and social support, and the complexity of managing multiple conditions, medications, and communicating with health care providers...

OBJECTIVES: To examine the population of inpatients with multiple hospitalizations at a large urban medical center in order to understand the types of patients who are at highest risk for 30-day readmission. STUDY DESIGN: Descriptive retrospective cohort analysis using hospital administrative data. METHODS: Bivariate analysis of clinical and sociodemographic characteristics of 19,049 adult inpatients discharged with a medical MS-DRG between July 1, 2009, and December 2010, and all subsequent inpatient admissions in the 180 days following each index discharge...

BACKGROUND AND PURPOSE: Chronic obstructive pulmonary disease (COPD) is frequently associated with various comorbidities. However, the proportion of COPD patients with dementia has not been adequately examined. This retrospective cohort study investigated the association between COPD and dementia by using a nationwide population-based database in Taiwan. METHODS: Data were retrieved from the Taiwanese National Health Insurance Research Database and analyzed using multivariate Cox proportional hazards regression models to assess the effects of COPD on the risk of dementia after adjusting for demographic characteristics and comorbidities...

BACKGROUND: Comorbidities are a major concern in heart failure, leading to adverse outcomes, increased health care utilization, and excess mortality. Nevertheless, the epidemiology of comorbid conditions and differences in their occurrence by type of heart failure and sex are not well documented. METHODS: The prevalence of 16 chronic conditions defined by the US Department of Health and Human Services was obtained among 1382 patients from Olmsted County, Minn. diagnosed with first-ever heart failure between 2000 and 2010...

PROBLEM IDENTIFICATION: To summarize the current state of nursing knowledge related to the association of multiple chronic conditions (MCCs) and cancer-related fatigue (CRF) in patients with solid tumors during chemotherapy. LITERATURE SEARCH: A systematic literature search of PubMed, CINAHL®, EMBASE, Cochrane, and ProQuest Dissertations and Theses for primary nursing research from January 2000 to June 2012 that examined the prevalence and/or severity of CRF with MCCs or a single comorbidity...

The objective of this research was to update earlier estimates of prevalence rates of single chronic conditions and multiple (>2) chronic conditions (MCC) among the noninstitutionalized, civilian US adult population. Data from the 2012 National Health Interview Survey (NHIS) were used to generate estimates of MCC for US adults and by select demographic characteristics. Approximately half (117 million) of US adults have at least one of the 10 chronic conditions examined (ie, hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, current asthma, or chronic obstructive pulmonary disease [COPD])...

BACKGROUND: Studies of patients with multiple chronic conditions using claims data are often missing important determinants of treatments and outcomes, such as function status and disease severity. We sought to identify and evaluate a class of function-related indicators (FRIs) from administrative claims data. POPULATION: The study cohort comprised US Medicare beneficiaries aged 65 years or older with Parts A and B fee-for-service and Part D coverage, with a hospitalization for acute myocardial infarction during 2007...

BACKGROUND: Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons. OBJECTIVE: To estimate life expectancy for elderly persons without a history of cancer, taking into account comorbid conditions. DESIGN: Population-based cohort study. SETTING: A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information...