Clinical Practice Guidelines and Quality of Care for Older Patients With Multiple Comorbid Diseases: Implications for Pay for Performance
Abstract
CONTEXT: Clinical practice guidelines (CPGs) have been developed to improve the quality of health care for many chronic conditions. Pay-for-performance initiatives assess physician adherence to interventions that may reflect CPG recommendations. OBJECTIVE: To evaluate the applicability of CPGs to the care of older individuals with several comorbid diseases. DATA SOURCES: The National Health Interview Survey and a nationally representative sample of Medicare beneficiaries (to identify the most prevalent chronic diseases in this population); the National Guideline Clearinghouse (for locating evidence-based CPGs for each chronic disease). STUDY SELECTION: Of the 15 most common chronic diseases, we selected hypertension, chronic heart failure, stable angina, atrial fibrillation, hypercholesterolemia, diabetes mellitus, osteoarthritis, chronic obstructive pulmonary disease, and osteoporosis, which are usually managed in primary care, choosing CPGs promulgated by national and international medical organizations for each. DATA EXTRACTION: Two investigators independently assessed whether each CPG addressed older patients with multiple comorbid diseases, goals of treatment, interactions between recommendations, burden to patients and caregivers, patient preferences, life expectancy, and quality of life. Differences were resolved by consensus. For a hypothetical 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension, and osteoarthritis, we aggregated the recommendations from the relevant CPGs. DATA SYNTHESIS: Most CPGs did not modify or discuss the applicability of their recommendations for older patients with multiple comorbidities. Most also did not comment on burden, short- and long-term goals, and the quality of the underlying scientific evidence, nor give guidance for incorporating patient preferences into treatment plans. If the relevant CPGs were followed, the hypothetical patient would be prescribed 12 medications (costing her 406 dollars per month) and a complicated nonpharmacological regimen. Adverse interactions between drugs and diseases could result. CONCLUSIONS: This review suggests that adhering to current CPGs in caring for an older person with several comorbidities may have undesirable effects. Basing standards for quality of care and pay for performance on existing CPGs could lead to inappropriate judgment of the care provided to older individuals with complex comorbidities and could create perverse incentives that emphasize the wrong aspects of care for this population and diminish the quality of their care. Developing measures of the quality of the care needed by older patients with complex comorbidities is critical to improving their care.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The quality of life in adults aging with HIV is in question due to medical complications, co-morbidities, polypharmacy, substance use, poorer mental health, social isolation, and stigmatization from healthcare providers and society at large.
“However, the quality of life in adults aging with HIV is in question due to medical complications, co-morbidities, polypharmacy, substance use, poorer mental health, social isolation, as well as stigmatization from healthcare providers and society at larger (75).”
From HIV and Aging: State of Knowledge and Areas of Critical Need for Research. A Report to the NIH Office of AIDS Research by the HIV and Aging Working Group (2012) · cites this paper as [75]
Cites
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944 · see citing works
Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., Barnes, P. J., Fabbri, L. M., Martinez, F. J., Nishimura, M., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201204-0596pp · Cited by 15,983 · see citing works
Crossing the Quality Chasm: A New Health System for the 21st Century
Baker, A. (2001) · BMJ · doi:10.1136/bmj.323.7322.1192 · Cited by 10,754 · see citing works
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus* (2002) · Diabetes Care · doi:10.2337/diacare.25.2007.s5 · Cited by 10,320 · see citing works
Standards of Medical Care in Diabetes
Power, D. V. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1593 · Cited by 8,672 · see citing works
Grundy, S. M., Cleeman, J. I., Merz, C. N. B., Brewer, H. B., Clark, L. T., Hunninghake, D. B., Pasternak, R. C., Smith, S. C., & Stone, N. J. (2004) · Circulation · doi:10.1161/01.cir.0000133317.49796.0e · Cited by 6,902 · see citing works
Global Initiative for Chronic Obstructive Lung Disease
Gerald, L. B., & Bailey, W. C. (2002) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200207000-00004 · Cited by 5,824 · see citing works
Organizing Care for Patients with Chronic Illness
Wagner, E. H., Austin, B. T., & Korff, M. V. (1996) · The Milbank Quarterly · doi:10.2307/3350391 · Cited by 2,877 · see citing works
Hunt, S. A., Baker, D. W., Chin, M. H., Cinquegrani, M. P., Feldman, A. M., Francis, G. S., Ganiats, T. G., Goldstein, S., Gregoratos, G., Jessup, M. L., et al. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01683-7 · Cited by 1,909 · see citing works
Current estimates from the National Health Interview Survey.
Ss, J. (1981) · PubMed · Cited by 1,866 · see citing works
Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting
Gurwitz, J. H., Field, T. S., Harrold, L. R., Rothschild, J. M., DeBellis, K. R., Seger, A. C., Cadoret, C. A., Fish, L. S., Garber, L., Kelleher, M., et al. (2003) · JAMA · doi:10.1001/jama.289.9.1107 · Cited by 1,666 · see citing works
Primary Care: Is There Enough Time for Prevention?
Yarnall, K. S. H., Pollak, K. I., Østbye, T., Krause, K. M., & Michener, J. L. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.4.635 · Cited by 1,641 · cited 1× · see citing works
“All elements of the treatment plan cannot easily be addressed in a 15-minute office visit.(55,56) Interactions that could result from concurrent adherence to all 5 CPGs (TABLE 4) include between a medica-”
BackgroundFranz, M. J., Bantle, J. P., Beebe, C. A., Brunzell, J. D., Chiasson, J.-L., Garg, A., Holzmeister, L. A., Hoogwerf, B., Mayer-Davis, E., Mooradian, A. D., et al. (2002) · Diabetes Care · doi:10.2337/diacare.25.1.148 · Cited by 1,165 · see citing works
Fong, D. S., Aiello, L. P., Gardner, T. W., King, G. L., Blankenship, G. W., Cavallerano, J. D., Ferris, F. L., & Klein, R. (2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s84 · Cited by 1,138 · see citing works
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.2007.s106 · Cited by 1,034 · see citing works
American Diabetes Association (2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s79 · Cited by 1,034 · see citing works
Cancer Screening in Elderly Patients: A Framework for Individualized Decision Making
Walter, L. C., & Covinsky, K. E. (2001) · JAMA · doi:10.1001/jama.285.21.2750 · Cited by 1,003 · see citing works
Persons With Chronic Conditions
Hoffman, C. (1996) · JAMA · doi:10.1001/jama.1996.03540180029029 · Cited by 973 · see citing works
Potential pitfalls of disease-specific guidelines for patients with multiple conditions.
Tinetti, M., Bogardus, S., & Agostini, J. V. (2004) · New England Journal of Medicine · doi:10.1056/nejmsb042458 · Cited by 969 · see citing works
Guidelines for the medical management of osteoarthritis
Hochberg, M. C., Altman, R. D., Brandt, K. D., Clark, B. M., Dieppe, P. A., Griffin, M. R., Moskowitz, R. W., & Schnitzer, T. J. (1995) · Arthritis & Rheumatism · doi:10.1002/art.1780381103 · Cited by 966 · see citing works
Causes and consequences of comorbidity
Gijsen, R., Hoeymans, N., Schellevis, F. G., Ruwaard, D., Satariano, W. A., & van den Bos, G. A. M. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00363-2 · Cited by 962 · see citing works
Are Guidelines Following Guidelines?
Shaneyfelt, T. M., Mayo‐Smith, M. F., & Rothwangl, J. (1999) · JAMA · doi:10.1001/jama.281.20.1900 · Cited by 846 · see citing works
Drug-Drug Interactions Among Elderly Patients Hospitalized for Drug Toxicity
Juurlink, D. N., Mamdani, M., Kopp, A., Laupacis, A., & Redelmeier, D. A. (2003) · JAMA · doi:10.1001/jama.289.13.1652 · Cited by 759 · see citing works
The Primary Care Assessment Survey
Safran, D. G., Kosinski, M. R., Tarlov, A. R., Rogers, W. H., Taira, D. A., Lieberman, N., & Ware, J. E. (1998) · Medical Care · doi:10.1097/00005650-199805000-00012 · Cited by 690 · see citing works
Guidelines for improving the care of the older person with diabetes mellitus
California Healthcare Foundation/American Geriatrics Society, C. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.51.5s.1.x · Cited by 651 · see citing works
Pauwels, R., Buist, A. S., Calverley, P., Jenkins, C. R., Hurd, S. S., & Lenfant, C. J. M. (2001) · Respiratory Care · doi:10.1177/002013240104600806 · Cited by 614 · see citing works
Hofer, T. P. (1999) · JAMA · doi:10.1001/jama.281.22.2098 · Cited by 502 · see citing works
Tinetti, M. E., & Fried, T. R. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2003.09.031 · Cited by 490 · see citing works
Shiffman, R. N., Shekelle, P., Overhage, J. M., Slutsky, J. R., Grimshaw, J., & Deshpande, A. M. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-139-6-200309160-00013 · Cited by 451 · see citing works
Dyslipidemia Management in Adults With Diabetes
American Diabetes Association (2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s68 · Cited by 444 · see citing works
Colwell, J. A. (1997) · Diabetes Care · doi:10.2337/diacare.20.11.1767 · Cited by 402 · see citing works
Nutrition Principles and Recommendations in Diabetes
American Diabetes Association (2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s36 · Cited by 396 · see citing works
The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients
Wenger, N. S., Solomon, D. H., Roth, C. P., MacLean, C. H., Saliba, D., KAMBERG, C. J., Rubenstein, L. Z., Young, R. T., Sloss, E. M., Louie, R., et al. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-139-9-200311040-00008 · Cited by 395 · see citing works
Users' Guides to the Medical Literature
Hayward, R. S. (1995) · JAMA · doi:10.1001/jama.1995.03530070068032 · Cited by 392 · see citing works
Masoudi, F. A., Havranek, E. P., Wolfe, P., Gross, C. P., Rathore, S. S., Steiner, J. F., Ordin, D. L., & Krumholz, H. M. (2003) · American Heart Journal · doi:10.1016/s0002-8703(03)00189-3 · Cited by 334 · see citing works
Medication Costs, Adherence, And Health Outcomes Among Medicare Beneficiaries
Mojtabai, R., & Olfson, M. (2003) · Health Affairs · doi:10.1377/hlthaff.22.4.220 · Cited by 322 · see citing works
Risk Factors for Adverse Drug Events Among Older Adults in the Ambulatory Setting
Field, T., Gurwitz, J., Harrold, L., Rothschild, J., Debellis, K., Seger, A., Auger, J. C., Garber, L., Cadoret, C. A., Fish, L., et al. (2004) · Journal of The American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52367.x · Cited by 315 · see citing works
Hypertension Management in Adults With Diabetes
Arauz-Pacheco, C., Parrott, M. A., & Raskin, P. (2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s65 · Cited by 281 · see citing works
Development and application of a generic methodology to assess the quality of clinical guidelines
Cluzeau, F., Littlejohns, P., Grimshaw, J., Feder, G. S., & Moran, S. (1999) · International Journal for Quality in Health Care · doi:10.1093/intqhc/11.1.21 · Cited by 271 · see citing works
Polypharmacy and Hospitalization Among Older Home Care Patients
Flaherty, J. H., Perry, H. M., Lynchard, G. S., & Morley, J. E. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.10.m554 · Cited by 236 · see citing works
Polypharmacy: a new paradigm for quality drug therapy in the elderly?
Gurwitz, J. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.18.1957 · Cited by 209 · see citing works
Medication Adherence in Elderly Patients Receiving Home Health Services following Hospital Discharge
Gray, S. L., Mahoney, J., & Blough, D. K. (2001) · Annals of Pharmacotherapy · doi:10.1345/aph.10295 · Cited by 209 · see citing works
Protheroe, J. (2001) · Western Journal of Medicine · doi:10.1136/ewjm.174.5.311 · Cited by 201 · see citing works
Preventive Foot Care in Diabetes
American Diabetes Association (2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s63 · Cited by 199 · see citing works
Pitfalls of Converting Practice Guidelines Into Quality Measures
Walter, L. C., Davidowitz, N. P., Heineken, P. A., & Covinsky, K. E. (2004) · JAMA · doi:10.1001/jama.291.20.2466 · Cited by 197 · see citing works
Managing multiple morbidity in mid-life: A qualitative study of attitudes to drug use
Townsend, A., Hunt, K., & Wyke, S. (2003) · BMJ · doi:10.1136/bmj.327.7419.837 · Cited by 181 · see citing works
Guidelines for the medical management of osteoarthritis, Part I. Osteoarthritis of the hip
Mc, H. (1995) · Medical Entomology and Zoology · Cited by 180 · see citing works
Reducing Polypharmacy in the Elderly
Kroenke, K., & Pinholt, E. M. (1990) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1990.tb01593.x · Cited by 137 · see citing works
A COMPARISON OF CLINICAL PRACTICE GUIDELINE APPRAISAL INSTRUMENTS
Graham, I. D., Calder, L. A., Hébert, P. C., Carter, A. O., & Tetroe, J. (2000) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462300103095 · Cited by 131 · see citing works
“Doing prescribing”: how doctors can be more effective
Elwyn, G. J., Edwards, A., & Britten, N. (2003) · BMJ · doi:10.1136/bmj.327.7419.864 · Cited by 115 · see citing works
Improving Diabetes Care in a Large Health Care System: An Enhanced Primary Care Approach
Sperl‐Hillen, J. M., O’Connor, P. J., Carlson, R. R., Bunkers-Lawson, T., Halstenson, C., Crowson, T. W., & Wuorenma, J. (2000) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(00)26052-5 · Cited by 97 · see citing works
Update of ACR Guidelines for Osteoarthritis
Schnitzer, T. J. (2002) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(02)00372-x · Cited by 95 · see citing works
Evidence-Based Guidelines As a Foundation For Performance Incentives
Garber, A. M. (2005) · Health Affairs · doi:10.1377/hlthaff.24.1.174 · Cited by 80 · see citing works
Hofer, T. P., Zemencuk, J. K., & Hayward, R. A. (2004) · Journal of General Internal Medicine · doi:10.1007/s11606-004-0058-0 · Cited by 62 · see citing works
Assessment of Patient Preferences: Integrating Treatments and Outcomes
Fried, T. R., Bradley, E. H., & Towle, V. R. (2002) · The Journals of Gerontology Series B · doi:10.1093/geronb/57.6.s348 · Cited by 62 · see citing works
Snow, V. T., Barry, P. P., Fihn, S. D., Gibbons, R. J., Owens, D. K., Williams, S. V., Mottur-Pilson, C., & Weiss, K. B. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-7-200410050-00014 · Cited by 60 · see citing works
Schmader, K. E., Hanlon, J. T., Fillenbaum, G. G., Huber, M., Pieper, C. F., & Horner, R. D. (1998) · Age and Ageing · doi:10.1093/ageing/27.4.493 · Cited by 59 · see citing works
Aging, Comorbidity, and Reduced Rates of Drug Treatment for Diabetes Mellitus
Glynn, R. J., Monane, M., Gurwitz, J. H., Choodnovskiy, I., & Avorn, J. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(99)00055-4 · Cited by 56 · see citing works
Greer, A. L., Goodwin, J. S., Freeman, J. L., & Wu, Z. H. (2002) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462302000569 · Cited by 53 · see citing works
Csako, G., McGriff, N. J., Rotman-Pikielny, P., Sarlis, N. J., & Pucino, F. (2001) · Annals of Pharmacotherapy · doi:10.1345/aph.1a031 · Cited by 40 · see citing works
Treating neurodegenerative diseases
Findley, L. J. J., & Baker, M. G. (2002) · BMJ · doi:10.1136/bmj.324.7352.1466 · Cited by 26 · see citing works
Trends in Prescribed Medicine Use and Spending by Older Americans, 1992-2001
Goulding, M. R. (2005) · PsycEXTRA Dataset · doi:10.1037/e620652007-001 · Cited by 3 · see citing works
Atsumi (2000) · doi:10.1002/1529-0131(200009)43:9
Flagged first, then by citations
Cited by
Sorted by citations
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60240-2 · Cited by 6,972 · see citing works
Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D.-C., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201309-1634st · Cited by 3,938 · see citing works
Clinical Practice Guidelines We Can Trust
Board on Health Care Services (2011) · National Academies Press eBooks · doi:10.17226/13058 · Cited by 3,102 · see citing works
Aging with multimorbidity: A systematic review of the literature
Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., Meinow, B., & Fratiglioni, L. (2011) · Ageing Research Reviews · doi:10.1016/j.arr.2011.03.003 · Cited by 3,092 · see citing works
The burden of disease in older people and implications for health policy and practice
Prince, M. J., Wu, F., Guo, Y., Gutiérrez‐Robledo, L. M., O'Donnell, M. J., Sullivan, R. J., & Yusuf, S. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61347-7 · Cited by 2,312 · see citing works
Frailty as a predictor of surgical outcomes in older patients
Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., Takenaga, R., Devgan, L., Holzmueller, C. G., Tian, J., et al. (2010) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2010.01.028 · Cited by 2,184 · see citing works
Clinical consequences of polypharmacy in elderly
Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2013) · Expert Opinion on Drug Safety · doi:10.1517/14740338.2013.827660 · Cited by 1,970 · see citing works
Reducing Inappropriate Polypharmacy
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Couteur, D. G. L., Rigby, D., Gnjidic, D., Mar, C. D., Roughead, E. E., Page, A. T., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.0324 · Cited by 1,594 · see citing works
Skou, S. T., Mair, F. S., Fortin, M., Guthrie, B., Nunes, B. P., Miranda, J. J., Boyd, C. M., Pati, S., Mtenga, S., & Smith, S. M. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00376-4 · Cited by 1,430 · see citing works
Best care at lower cost: the path to continuously learning health care in America
Smith, M. A., Saunders, R., Stuckhardt, L., & McGinnis, J. M. (2014) · Choice Reviews Online · doi:10.5860/choice.51-3277 · Cited by 1,356 · see citing works
Edwards, B. K., Noone, A., Mariotto, A. B., Simard, E. P., Boscoe, F. P., Henley, S. J., Jemal, A., Cho, H., Anderson, R. N., Kohler, B., et al. (2013) · Cancer · doi:10.1002/cncr.28509 · Cited by 1,210 · see citing works
Vogeli, C., Shields, A. E., Lee, T. A., Gibson, T. B., Marder, W. D., Weiss, K. B., & Blumenthal, D. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0322-1 · Cited by 1,150 · see citing works
Appropriate prescribing in elderly people: how well can it be measured and optimised?
Spinewine, A., Schmader, K. E., Barber, N., Hughes, C. M., Lapane, K. L., Swine, C., & Hanlon, J. T. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61091-5 · Cited by 1,090 · see citing works
Designing Health Care for the Most Common Chronic Condition—Multimorbidity
Tinetti, M. E., Fried, T. R., & Boyd, C. M. (2012) · JAMA · doi:10.1001/jama.2012.5265 · Cited by 1,005 · see citing works
Chronic obstructive pulmonary disease
Decramer, M., Janssens, W., & Miravitlles, M. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60968-9 · Cited by 975 · see citing works
Riegel, B. J., Moser, D. K., Anker, S. D., Appel, L. J., Dunbar, S. B., Grady, K. L., Gurvitz, M. Z., Havranek, E. P., Lee, C. S., Lindenfeld, J. M., et al. (2009) · Circulation · doi:10.1161/circulationaha.109.192628 · Cited by 959 · see citing works
The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010
Guthrie, B., Makubate, B., Santiago, V. H., & Dreischulte, T. (2015) · BMC Medicine · doi:10.1186/s12916-015-0322-7 · Cited by 839 · see citing works
Multimorbidity patterns: a systematic review
Prados‐Torres, A., Calderón‐Larrañaga, A., Hancco-Saavedra, J. A., Poblador‐Plou, B., & van den Akker, M. (2014) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2013.09.021 · Cited by 806 · see citing works
Interventions to improve the appropriate use of polypharmacy for older people
Patterson, S. M., Cadogan, C. A., Kerse, N. M., Cardwell, C. R., Bradley, M. C., Ryan, C. A., & Hughes, C. M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008165.pub3 · Cited by 759 · see citing works
Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions
Lehnert, T., Heider, D., Leicht, H., Heinrich, S., Corrieri, S., Luppa, M., Riedel-Heller, S. G., & König, H. (2011) · Medical Care Research and Review · doi:10.1177/1077558711399580 · Cited by 753 · see citing works
The Impact of Comorbid Chronic Conditions on Diabetes Care
Piette, J. D., & Kerr, E. A. (2006) · Diabetes Care · doi:10.2337/diacare.29.03.06.dc05-2078 · Cited by 727 · see citing works
Health Outcomes Associated with Polypharmacy in Community‐Dwelling Older Adults: A Systematic Review
Fried, T. R., O’Leary, J. R., Towle, V. R., Goldstein, M. K., Trentalange, M. J., & Martin, D. K. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13153 · Cited by 727 · see citing works
Ageing and the epidemiology of multimorbidity
Divo, M. J., Martinez, C. H., & Mannino, D. M. (2014) · European Respiratory Journal · doi:10.1183/09031936.00059814 · Cited by 705 · see citing works
Boyd, C. M., & Fortin, M. (2010) · Public health reviews · doi:10.1007/bf03391611 · Cited by 680 · see citing works
Complex chronic comorbidities of COPD
Fabbri, L. M., Luppi, F., Beghé, B., & Rabe, K. F. (2008) · European Respiratory Journal · doi:10.1183/09031936.00114307 · Cited by 660 · see citing works
Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04188.x · Cited by 667 · see citing works
An update on the clinical consequences of polypharmacy in older adults: a narrative review
Wastesson, J. W., Morin, L., Tan, E. C. K., & Johnell, K. (2018) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2018.1546841 · Cited by 617 · see citing works
From COPD to chronic systemic inflammatory syndrome?
Fabbri, L. M., & Rabe, K. F. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61383-x · Cited by 633 · see citing works
Self‐Care for the Prevention and Management of Cardiovascular Disease and Stroke
Riegel, B. J., Moser, D. K., Buck, H. G., Dickson, V. V., Dunbar, S. B., Lee, C. S., Lennie, T. A., Lindenfeld, J. M., Mitchell, J. E., Treat‐Jacobson, D., et al. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.006997 · Cited by 640 · see citing works
Grand challenges in clinical decision support
Sittig, D. F., Wright, A., Osheroff, J. A., Middleton, B., Teich, J. M., Ash, J. S., Campbell, E., & Bates, D. W. (2008) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2007.09.003 · Cited by 582 · see citing works
Fabbri, E., Zoli, M., González‐Freire, M., Salive, M. E., Studenski, S. A., & Ferrucci, L. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.03.013 · Cited by 560 · see citing works
Multimorbidity in chronic disease: impact on health care resources and costs
McPhail, S. (2016) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s97248 · Cited by 555 · see citing works
Effros, R. B., Fletcher, C. V., Gebo, K., Halter, J. B., Hazzard, W. R., Horne, F. M., Huebner, R. E., Janoff, E. N., Justice, A. C., Kuritzkes, D., et al. (2008) · Clinical Infectious Diseases · doi:10.1086/590150 · Cited by 539 · see citing works
Garfinkel, D., & Mangin, D. A. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.355 · Cited by 537 · see citing works
Polypharmacy and Prescribing Quality in Older People
Steinman, M. A., Landefeld, C., Rosenthal, G. E., Berthenthal, D., Sen, Ś., & Kaboli, P. (2006) · Journal of The American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00889.x · Cited by 580 · see citing works
Adapting clinical guidelines to take account of multimorbidity
Guthrie, B., Payne, K., Alderson, P., McMurdo, M. E. T., & Mercer, S. W. (2012) · BMJ · doi:10.1136/bmj.e6341 · Cited by 530 · see citing works
Heart Failure-Related Hospitalization in the U.S., 1979 to 2004
Fang, J., Mensah, G. A., Croft, J. B., & Keenan, N. L. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.03.061 · Cited by 527 · see citing works
High, K. P., Brennan-Ing, M., Clifford, D. B., Cohen, M. H., Currier, J., Deeks, S. G., Deren, S., Effros, R. B., Gebo, K., Goronzy, J. J., et al. (2012) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e31825a3668 · Cited by 522 · see citing works
Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients
Joseph, B. A., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O’Keeffe, T., Tang, A. L., Vercruysse, G. A., Fain, M. J., et al. (2014) · JAMA Surgery · doi:10.1001/jamasurg.2014.296 · Cited by 496 · see citing works
Multimorbidity in Older Adults With Cardiovascular Disease
Forman, D. E., Maurer, M. S., Boyd, C., Brindis, R., Salive, M. E., Horne, F. M., Bell, S. P., Fulmer, T., Reuben, D. B., Zieman, S., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.03.022 · Cited by 484 · see citing works
Kabisch, N., van den Bosch, M. A., & Lafortezza, R. (2017) · Environmental Research · doi:10.1016/j.envres.2017.08.004 · Cited by 492 · see citing works
Bähler, C., Huber, C. A., Brüngger, B., & Reich, O. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0698-2 · Cited by 482 · see citing works
Lugtenberg, M., Schaick, J. M. Z.-V., Westert, G. P., & Burgers, J. S. (2009) · Implementation Science · doi:10.1186/1748-5908-4-54 · Cited by 479 · see citing works
Perianayagam, A., Uttamacharya, U., Jain, K., Biritwum, R. B., Yawson, A. E., Wu, F., Guo, Y., Maximova, T., Manrique-Espinoza, B. S., Salinas‐Rodríguez, A., et al. (2015) · BMC Medicine · doi:10.1186/s12916-015-0402-8 · Cited by 484 · see citing works
Ruger, J. P. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17064-5 · Cited by 465 · see citing works
Patterns of Chronic Multimorbidity in the Elderly Population
Marengoni, A., Rizzuto, D., Wang, H., Winblad, B. G., & Fratiglioni, L. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02109.x · Cited by 421 · see citing works
Peng, P. D., van Vledder, M. G., Tsai, S., Jong, M. C. D., Makary, M. M., Ng, J., Edil, B. H., Wolfgang, C. L., Schulick, R. D., Choti, M. A., et al. (2011) · HPB · doi:10.1111/j.1477-2574.2011.00301.x · Cited by 415 · see citing works
Hughes, L. D., McMurdo, M. E. T., & Guthrie, B. (2013) · Age and Ageing · doi:10.1093/ageing/afs100 · Cited by 506 · see citing works
Gibson, P. G., McDonald, V. M., & Marks, G. B. (2010) · The Lancet · doi:10.1016/s0140-6736(10)61087-2 · Cited by 395 · see citing works
Sinnott, C., McHugh, S., Browne, J. P., & Bradley, C. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003610 · Cited by 393 · see citing works
Age-Related Pharmacokinetic and Pharmacodynamic Changes and Related Risk of Adverse Drug Reactions
Corsonello, A., Pedone, C., & Incalzi, R. A. (2010) · Current Medicinal Chemistry · doi:10.2174/092986710790416326 · Cited by 393 · see citing works
Schäfer, I., von Leitner, E.-C., Schön, G., Koller, D., Hansen, H., Kolonko, T., Kaduszkiewicz, H., Wegscheider, K., Glaeske, G., & van den Bussche, H. (2010) · PLoS ONE · doi:10.1371/journal.pone.0015941 · Cited by 387 · see citing works
The Persistent Exclusion of Older Patients From Ongoing Clinical Trials Regarding Heart Failure
Cherubini, A., Oristrell, J., Pla, X., Ruggiero, C., Ferretti, R., Diestre, G., Clarfield, A. M., Crome, P., Hertogh, C. M. P. M., Lesauskaitė, V., et al. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.31 · Cited by 370 · see citing works
Is Patient-Centered Care the Same As Person-Focused Care?
Starfield, B. H. (2011) · The Permanente Journal · doi:10.7812/tpp/10-148 · Cited by 362 · see citing works
The Effects of Polypharmacy in Older Adults
Hilmer, S. N., & Gnjidic, D. (2008) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2008.224 · Cited by 363 · see citing works
Ekerstad, N., Swahn, E., Janzon, M., Alfredsson, J., Löfmark, R., Lindenberger, M., & Carlsson, P. (2011) · Circulation · doi:10.1161/circulationaha.111.025452 · Cited by 357 · see citing works
Challenges of managing people with multimorbidity in today’s healthcare systems
Moffat, K., & Mercer, S. W. (2015) · BMC Family Practice · doi:10.1186/s12875-015-0344-4 · Cited by 355 · see citing works
Understanding Health Care as a Complex System
Lipsitz, L. A. (2012) · JAMA · doi:10.1001/jama.2012.7551 · Cited by 349 · see citing works
Marengoni, A., Strauss, E. I. V., Rizzuto, D., Winblad, B. G., & Fratiglioni, L. (2008) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2008.02017.x · Cited by 349 · see citing works
Parekh, A. K., Goodman, R. A., Gordon, C., Koh, H. K., & Conditions, T. H. I. W. O. M. C. (2011) · Public Health Reports · doi:10.1177/003335491112600403 · Cited by 345 · see citing works
Dumbreck, S., Flynn, A., Nairn, M., Wilson, M., Treweek, S. P., Mercer, S. W., Alderson, P., Thompson, A., Payne, K., & Guthrie, B. (2015) · BMJ · doi:10.1136/bmj.h949 · Cited by 339 · see citing works
Kerr, E. A., Heisler, M., Krein, S. L., Kabeto, M., Langa, K. M., Weir, D., & Piette, J. D. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0313-2 · Cited by 330 · see citing works
Processes of care desired by elderly patients with multimorbidities
Bayliss, E. A., Edwards, A. E., Steiner, J. F., & Main, D. S. (2008) · Family Practice · doi:10.1093/fampra/cmn040 · Cited by 328 · see citing works
The Anatomy of Health Care in the United States
Moses, H., Matheson, D. H. M., Dorsey, E. R., George, B. P., Sadoff, D., & Yoshimura, S. (2013) · JAMA · doi:10.1001/jama.2013.281425 · Cited by 328 · see citing works
Multimorbidity: redesigning health care for people who use it
Salisbury, C. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60482-6 · Cited by 326 · see citing works
Radovanović, D., Seifert, B., Urban, P. M., Eberli, F. R., Rickli, H., Bertel, O., Puhan, M. A., Erné, P., & on behalf of the AMIS Plus Investigators (2013) · Heart · doi:10.1136/heartjnl-2013-304588 · Cited by 321 · see citing works
Trends in Comorbidity, Disability, and Polypharmacy in Heart Failure
Wong, C. Y., Chaudhry, S. I., Desai, M. M., & Krumholz, H. M. (2011) · The American Journal of Medicine · doi:10.1016/j.amjmed.2010.08.017 · Cited by 319 · see citing works
Managing Medications in Clinically Complex Elders
Steinman, M. A., & Hanlon, J. T. (2010) · JAMA · doi:10.1001/jama.2010.1482 · Cited by 320 · see citing works
Boyd, C. M., Smith, C. D., Masoudi, F. A., Blaum, C. S., Dodson, J. A., Green, A. R., Kelley, A. S., Matlock, D. D., Ouellet, J. A., Rich, M. W., et al. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15809 · Cited by 315 · see citing works
On behalf of SIMI Investigators, Nobili, A., Licata, G., Salerno, F., Pasina, L., Tettamanti, M., Franchi, C., Vittorio, L. D., Marengoni, A., Corrao, S., et al. (2011) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-010-0977-0 · Cited by 313 · see citing works
HIV and aging: time for a new paradigm.
Justice, A. C. (2010) · Current HIV/AIDS Reports · doi:10.1007/s11904-010-0041-9 · Cited by 309 · see citing works
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04187.x · Cited by 309 · see citing works
Multimorbidity: What Do We Know? What Should We Do?
Navickas, R., Petric, V.-K., Feigl, A. B., & Seychell, M. (2016) · Journal of Comorbidity · doi:10.15256/joc.2016.6.72 · Cited by 300 · see citing works
Nobili, A., Garattini, S. K., & Mannucci, P. M. (2011) · Journal of Comorbidity · doi:10.15256/joc.2011.1.4 · Cited by 301 · see citing works
Patient Complexity: More Than Comorbidity. The Vector Model of Complexity
Safford, M. M., Allison, J. J., & Kiefe, C. I. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0307-0 · Cited by 300 · see citing works
Shekelle, P., Woolf, S. H., Grimshaw, J., Schünemann, H. J., & Eccles, M. (2012) · Implementation Science · doi:10.1186/1748-5908-7-62 · Cited by 294 · see citing works
Comorbidity in older adults with cancer
Williams, G. R., MacKenzie, A. R., Magnuson, A. M., Olin, R. L., Chapman, A. E., Mohile, S. G., Allore, H. G., Somerfield, M. R., Targia, V., Extermann, M., et al. (2015) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2015.12.002 · Cited by 298 · see citing works
Muth, C., Blom, J. W., Smith, S. M., Johnell, K., Gonzalez‐Gonzalez, A. I., Nguyen, T. S., Brueckle, M. ‐., Cesari, M., Tinetti, M. E., & Valderas, J. M. (2019) · Journal of Internal Medicine · doi:10.1111/joim.12842 · Cited by 339 · see citing works
Schäfer, I., Hansen, H., Schön, G., Höfels, S., Altiner, A., Dahlhaus, A., Gensichen, J., Riedel-Heller, S., Weyerer, S., Blank, W. A., et al. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-89 · Cited by 296 · see citing works
Failure of Clinical Practice Guidelines to Meet Institute of Medicine Standards
Kung, J., Miller, R. R., & Mackowiak, P. A. (2012) · Archives of Internal Medicine · doi:10.1001/2013.jamainternmed.56 · Cited by 293 · see citing works
The Ariadne principles: how to handle multimorbidity in primary care consultations
Muth, C., van den Akker, M., Blom, J. W., Mallen, C. D., Rochon, J., Schellevis, F., Becker, A., Beyer, M., Gensichen, J. S., Kirchner, H., et al. (2014) · BMC Medicine · doi:10.1186/s12916-014-0223-1 · Cited by 298 · see citing works
Reassessment of Clinical Practice Guidelines
Shaneyfelt, T. M., & Centor, R. M. (2009) · JAMA · doi:10.1001/jama.2009.225 · Cited by 293 · see citing works
Knowledge Gaps in Cardiovascular Care of the Older Adult Population
Rich, M. W., Chyun, D. A., Skolnick, A. H., Alexander, K. P., Forman, D. E., Kitzman, D. W., Maurer, M. S., McClurken, J. B., Resnick, B. M., Shen, W. K., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.03.004 · Cited by 289 · see citing works
Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis
Joseph, B. A., Pandit, V., Zangbar, B., Kulvatunyou, N., Tang, A. L., O’Keeffe, T., Green, D. J., Vercruysse, G. A., Fain, M. J., Friese, R. S., et al. (2014) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2014.03.020 · Cited by 285 · see citing works
Ryan, R. E., Santesso, N., Lowe, D., Hill, S., Grimshaw, J. M., Prictor, M., Kaufman, C., Cowie, G., & Taylor, M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007768.pub3 · Cited by 273 · see citing works
Agustí, A. G. N., & Soriano, J. B. (2008) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412550801941349 · Cited by 280 · see citing works
Tran, V.-T., Montori, V. M., Eton, D. T., Baruch, D., Falissard, B., & Ravaud, P. (2012) · BMC Medicine · doi:10.1186/1741-7015-10-68 · Cited by 278 · see citing works
Schnell, K. M., Weiss, C. O., Lee, T. A., Krishnan, J. A., Leff, B. A., Wolff, J. L., & Boyd, C. M. (2012) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-12-26 · Cited by 275 · see citing works
Guthrie, B., Saultz, J. W., Freeman, G. K., & Haggerty, J. L. (2008) · BMJ · doi:10.1136/bmj.a867 · Cited by 275 · see citing works
Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review
Nicholson, K., Liu, W., Fitzpatrick, D. W. D., Hardacre, K. A., Roberts, S., Salerno, J., Stranges, S., Fortin, M., & Mangin, D. A. (2024) · The Lancet Healthy Longevity · doi:10.1016/s2666-7568(24)00007-2 · Cited by 310 · see citing works
The Co‐Occurrence of Chronic Diseases and Geriatric Syndromes: The Health and Retirement Study
Lee, P. G., Cigolle, C., & Blaum, C. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02150.x · Cited by 264 · see citing works
Medication Non-Adherence Among Elderly Patients Newly Discharged and Receiving Polypharmacy
Pasina, L., Brucato, A. L., Falcone, C., Cucchi, E. W., Bresciani, A., Sottocorno, M., Taddei, G. C., Casati, M., Franchi, C., Djade, C. D., et al. (2014) · Drugs & Aging · doi:10.1007/s40266-014-0163-7 · Cited by 266 · see citing works
The Next Step in Guideline Development
Krahn, M. D., & Naglie, G. (2008) · JAMA · doi:10.1001/jama.300.4.436 · Cited by 265 · see citing works
Relationship between Number of Medical Conditions and Quality of Care
Higashi, T., Wenger, N. S., Adams, J., Fung, C. H., Roland, M. O., McGlynn, E. A., Reeves, D., Asch, S. M., Kerr, E. A., & Shekelle, P. (2007) · New England Journal of Medicine · doi:10.1056/nejmsa066253 · Cited by 262 · see citing works
Gómez‐Batiste, X., Martínez-Muñoz, M., Blay, C., Amblàs-Novellas, J., Vila, L. C., Costa, X., Espaulella, J., Espinosa, J., Constante, C., & Mitchell, G. K. (2014) · Palliative Medicine · doi:10.1177/0269216313518266 · Cited by 264 · see citing works
Multimorbidity of chronic diseases and health care utilization in general practice
van Oostrom, S. H., Picavet, H. S. J., de Bruin, S. R., Stirbu, I., Korevaar, J. C., Schellevis, F., & Baan, C. A. (2014) · BMC Family Practice · doi:10.1186/1471-2296-15-61 · Cited by 265 · see citing works
Tran, V.-T., Harrington, M. A., Montori, V. M., Barnes, C., Wicks, P. J., & Ravaud, P. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-109 · Cited by 266 · see citing works
Quality of Care of People With Type 2 Diabetes in Eight European Countries
Stone, M. A., Charpentier, G., Doggen, K., Kuß, O., Lindblad, U., Kellner, C., Nolan, J. J., Pazderska, A., Rutten, G. E. H. M., Trento, M., et al. (2013) · Diabetes Care · doi:10.2337/dc12-1759 · Cited by 258 · see citing works
Prevalence of comorbidity of chronic diseases in Australia
Caughey, G. E., Vitry, A. I., Gilbert, A. L., & Roughead, E. E. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-221 · Cited by 256 · see citing works
Opondo, D., Eslami, S., Visscher, S., de Rooij, S. E., Verheij, R. A., Korevaar, J. C., & Abu–Hanna, A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043617 · Cited by 256 · see citing works
- Authors
- Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W.
- Affiliations
- Johns Hopkins University (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2005-08-10
- Volume
- 294
- Issue
- 6
- Pages
- 716
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2019286098
- Cited by
- 2,581
- References
- 66
- Citations by year
- 2026: 72 · 2025: 61 · 2024: 96 · 2023: 79 · 2022: 100 · 2021: 94 · 2020: 122 · 2019: 127 · 2018: 121 · 2017: 135 · 2016: 163 · 2015: 168 · 2014: 170 · 2013: 228 · 2012: 142
- FWCI
- 71.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5t32ag000120-25)
- National Institute on Aging (T32-AG-00120, P30AG021334)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- older adults, multiple comorbidities, guideline applicability, quality of care, performance-based pay, chronic disease, medication burden, drug interactions, patient preferences, quality of life, chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension, osteoarthritis, chronic heart failure, atrial fibrillation, hypercholesterolemia, primary care
- MeSH terms
- Aged, Chronic Disease, Geriatrics, Medicare, Humans, Primary Health Care, Quality Assurance, Health Care, Reimbursement, Incentive, United States, Comorbidity, Outcome Assessment, Health Care, Cost of Illness, Practice Guidelines as Topic, Guideline Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
