title: A conceptual model of the role of complexity in the care of patients with multiple chronic conditions.
abstract: BACKGROUND
  Effective healthcare for people with multiple chronic conditions (MCC) is a US priority, but the inherent complexity makes both research and delivery of care particularly challenging. As part of AHRQ Multiple Chronic Conditions Research Network (MCCRN) efforts, the Network developed a conceptual model to guide research in this area.
  
  
  OBJECTIVE
  To synthesize methodological and topical issues relevant to MCC patient care into a framework that can improve the delivery of care and advance future research about caring for patients with MCC.
  
  
  METHODS
  The Network synthesized essential constructs for MCC research identified from roundtable discussion, input from expert advisors, and previously published models.
  
  
  RESULTS
  The AHRQ MCCRN conceptual model defines complexity as the gap between patient needs and healthcare services, taking into account both the multiple considerations that affect the needs of MCC patients, as well as the contextual factors that influence service delivery. The model reframes processes and outcomes to include not only clinical care quality and experience, but also patient health, well being, and quality of life. The single-condition paradigm for treating needs one-by-one falls apart and highlights the need for care systems to address dynamic patient needs.
  
  
  CONCLUSIONS
  Defining complexity in terms of the misalignment between patient needs and services offers new insights in how to research and develop solutions to patient care needs.
authors.affiliation: *Department of Health Services, University of Washington †MacColl Center for Healthcare Innovation, Group Health Research Institute, Seattle, WA ‡Denver Health and Hospital Authority, Denver, CO §Palo Alto Medical Foundation Research Institute, Palo Alto, CA ∥Agency for Healthcare Research and Quality, Center for Primary Care, Prevention, and Clinical Partnerships, Rockville, MD ¶Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford #Abt Associates, Cambridge, MA.
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.forename: Judith
authors.initials: J
authors.lastname: Schaefer
authors.forename: Karin E
authors.initials: KE
authors.lastname: Johnson
authors.forename: Henry
authors.initials: H
authors.lastname: Fischer
authors.forename: Susan L
authors.initials: SL
authors.lastname: Moore
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.forename: Richard
authors.initials: R
authors.lastname: Ricciardi
authors.forename: James R
authors.initials: JR
authors.lastname: Fraser
authors.forename: Donald
authors.initials: D
authors.lastname: Miller
authors.forename: Lisa
authors.initials: L
authors.lastname: LeRoy
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003695:Delivery of Health Care / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D006801:Humans; D033183:Interdisciplinary Communication; D008962:Models, Theoretical; D020380:Needs Assessment / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology