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Defining Multiple Chronic Conditions for Quality Measurement
Elizabeth E Drye1, Faseeha K Altaf, Kasia J Lipska
1Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
Background/Objective:
Patients with multiple chronic conditions (MCCs) are a critical but undefined group for quality measurement. We present a generally applicable systematic approach to defining an MCC cohort of Medicare fee-for-service beneficiaries that we developed for a national quality measure, risk-standardized rates of unplanned admissions for Accountable Care Organizations.
Research Design:
To define the MCC cohort we: (1) identified potential chronic conditions; (2) set criteria for cohort conditions based on MCC framework and measure concept; (3) applied the criteria informed by empirical analysis, experts, and the public; (4) described "broader" and "narrower" cohorts; and (5) selected final cohort with stakeholder input.
Subjects:
Subjects were patients with chronic conditions. Participants included 21.8 million Medicare fee-for-service beneficiaries in 2012 aged 65 years and above with ≥1 of 27 Medicare Chronic Condition Warehouse condition(s).
Results:
In total, 10 chronic conditions were identified based on our criteria; 8 of these 10 were associated with notably increased admission risk when co-occurring. A broader cohort (2+ of the 8 conditions) included 4.9 million beneficiaries (23% of total cohort) with an admission rate of 70 per 100 person-years. It captured 53% of total admissions. The narrower cohort (3+ conditions) had 2.2 million beneficiaries (10%) with 100 admissions per 100 person-years and captured 32% of admissions. Most stakeholders viewed the broader cohort as best aligned with the measure concept.
Conclusions:
By systematically narrowing chronic conditions to those most relevant to the outcome and incorporating stakeholder input, we defined an MCC admission measure cohort supported by stakeholders. This approach can be used as a model for other MCC outcome measures.
Insights
Defining multiple chronic conditions (MCCs) is crucial for quality measurement. A systematic approach identified 10 key conditions, creating broader and narrower cohorts for better patient care and outcome analysis.
Area of Science:
- Health Services Research
- Quality Measurement
- Chronic Disease Management
Background:
- Patients with multiple chronic conditions (MCCs) represent a critical population for healthcare quality measurement.
- Existing quality measures often lack precise definitions for MCC cohorts, hindering accurate assessment.
- A systematic approach is needed to define MCC cohorts for Medicare beneficiaries.
Purpose of the Study:
- To develop a generally applicable, systematic approach for defining a multiple chronic conditions (MCC) cohort.
- To create a defined MCC cohort for a national quality measure assessing risk-standardized rates of unplanned admissions.
- To establish a framework for quality measurement in the Medicare fee-for-service population.
Main Methods:
- Identified potential chronic conditions from the Medicare Chronic Condition Warehouse.
- Established criteria for cohort conditions based on the MCC framework and measure objectives.
- Applied criteria using empirical analysis, expert input, and public feedback.
- Defined and described both broader (2+ conditions) and narrower (3+ conditions) MCC cohorts.
- Selected the final MCC cohort through stakeholder engagement.
Main Results:
- Ten chronic conditions were identified as relevant based on defined criteria.
- Eight of the ten conditions were associated with increased admission risk when co-occurring.
- A broader MCC cohort (≥2 conditions) comprised 4.9 million beneficiaries (23%) with a 70 admissions per 100 person-years rate.
- A narrower MCC cohort (≥3 conditions) included 2.2 million beneficiaries (10%) with a 100 admissions per 100 person-years rate.
- The broader cohort captured 53% of total admissions, while the narrower cohort captured 32%.
Conclusions:
- A systematic, stakeholder-informed approach successfully defined a relevant MCC cohort for quality measurement.
- The defined broader MCC cohort (≥2 conditions) was favored by stakeholders for aligning with measure concepts.
- This methodology provides a transferable model for developing other MCC outcome measures.
- The defined cohort facilitates improved quality measurement for patients with multiple chronic conditions.
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