title: Healthcare task difficulty among older adults with multimorbidity.
abstract: BACKGROUND
  Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden.
  
  
  OBJECTIVE
  To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity.
  
  
  METHODS
  Cross-sectional and longitudinal secondary data analysis.
  
  
  METHODS
  Multimorbid adults aged 65 years or older from primary care clinics.
  
  
  METHODS
  We generated a scale (0-16) of self-reported difficulty with 8 HCTD and conducted factor analysis to assess its dimensionality and internal consistency. To assess predictive ability, cross-sectional associations of HCTD and number of chronic diseases, and conditions that add to health status complexity (falls, visual, and hearing impairment), patient activation, patient-reported quality of chronic illness care (Patient Assessment of Chronic Illness Care), mental and physical health (SF-36) were tested using statistical tests for trend (n=904). Longitudinal analyses of the effects of change in HCTD on changes in the outcomes were conducted among a subset (n=370) with ≥1 follow-up at 6 and/or 18 months. All models were adjusted for age, education, sex, race, and time.
  
  
  RESULTS
  Greater HCTD was associated with worse mental and physical health [Cuzick test for trend (P<0.05)], and patient-reported quality of chronic illness care (P<0.05). In longitudinal analysis, increasing patient activation was associated with declining HCTD over time (P<0.01). Increasing HCTD over time was associated with declining mental (P<0.001) and physical health (P=0.001) and patient-reported quality of chronic illness care (P<0.05).
  
  
  CONCLUSIONS
  The findings of this study establish the construct validity of the HCTD scale.
authors.affiliation: *Department of Medicine, Johns Hopkins University School of Medicine †Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ‡NCQA §PCORI, Washington, DC.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Erin
authors.initials: E
authors.lastname: Giovannetti
authors.forename: Lisa
authors.initials: L
authors.lastname: Reider
authors.forename: Carlos
authors.initials: C
authors.lastname: Weiss
authors.forename: Qian-li
authors.initials: QL
authors.lastname: Xue
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
authors.forename: Travonia
authors.initials: T
authors.lastname: Hughes
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D057566:Self Report; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States / Q000453:epidemiology