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Defining Multiple Chronic Conditions for Quality Measurement.

Elizabeth E Drye1, Faseeha K Altaf, Kasia J Lipska

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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.

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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.