title: Framework for evaluating disease severity measures in older adults with comorbidity.
abstract: BACKGROUND
  Accounting for the influence of concurrent conditions on health and functional status for both research and clinical decision-making purposes is especially important in older adults. Although approaches to classifying severity of individual diseases and conditions have been developed, the utility of these classification systems has not been evaluated in the presence of multiple conditions.
  
  
  METHODS
  We present a framework for evaluating severity classification systems for common chronic diseases. The framework evaluates the: (a) goal or purpose of the classification system; (b) physiological and/or functional criteria for severity graduation; and (c) potential reliability and validity of the system balanced against burden and costs associated with classification.
  
  
  RESULTS
  Approaches to severity classification of individual diseases were not originally conceived for the study of comorbidity. Therefore, they vary greatly in terms of objectives, physiological systems covered, level of severity characterization, reliability and validity, and costs and burdens. Using different severity classification systems to account for differing levels of disease severity in a patient with multiple diseases, or, assessing global disease burden may be challenging.
  
  
  CONCLUSIONS
  Most approaches to severity classification are not adequate to address comorbidity. Nevertheless, thoughtful use of some existing approaches and refinement of others may advance the study of comorbidity and diagnostic and therapeutic approaches to patients with multimorbidity.
authors: Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD 21224, USA. cyboyd@jhmi.edu
authors: Cynthia M
authors: CM
authors: Boyd
authors: Carlos O
authors: CO
authors: Weiss
authors: Jeff
authors: J
authors: Halter
authors: K Carol
authors: KC
authors: Han
authors: William B
authors: WB
authors: Ershler
authors: Linda P
authors: LP
authors: Fried
mesh_terms: D000203:Activities of Daily Living; D002908:Chronic Disease / Q000145:classification*; D003362:Cost-Benefit Analysis; D006304:Health Status; D006801:Humans; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012720:Severity of Illness Index