Multimorbidity is associated with better quality of care among vulnerable elders.
BACKGROUND
Older patients with multiple chronic conditions may be at higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions. Possible reasons include competing guidelines for individual conditions, burden of numerous recommendations, and difficulty implementing treatments for multiple conditions.


OBJECTIVE
We sought to determine whether coexisting combinations of 8 common chronic conditions (hypertension, coronary artery disease, chronic obstructive pulmonary disease, osteoarthritis, diabetes mellitus, depression, osteoporosis, and having atrial fibrillation or congestive heart failure) are associated with overall quality of care among vulnerable older patients.


METHODS
Using an observational cohort study, we enrolled 372 community-dwelling persons 65 years of age or older who were at increased risk for death or functional decline within 2 years. We included (1) a comprehensive measure (% of quality indicators satisfied) of quality of medical and geriatric care that accounted for patient preference and appropriateness in light of limited life expectancy and advanced dementia, and (2) a measure of multimorbidity, either as a simple count of conditions or as a combination of specific conditions.


RESULTS
: Multimorbidity was associated with greater overall quality scores: mean proportion of quality indicators satisfied increased from 47% for elders with none of the prespecified conditions to 59% for those with 5 or 6 conditions (P < 0.0001), after controlling for number of office visits. Patients with greater multimorbidity also received care that was better than would be expected based on the specific set of quality indicators they triggered.


CONCLUSIONS
Among older persons at increased risk of death or functional decline, multimorbidity results in better, rather than worse, quality of care.
Min
Lillian C
LC
David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1687, USA. lmin@mednet.ucla.edu
Wenger
Neil S
NS
Fung
Constance
C
Chang
John T
JT
Ganz
David A
DA
Higashi
Takahiro
T
Kamberg
Caren J
CJ
MacLean
Catherine H
CH
Roth
Carol P
CP
Solomon
David H
DH
Young
Roy T
RT
Reuben
David B
DB
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations