Cited by 619Chronic Disease Management StrategiesPrimary Care and Health OutcomesPharmaceutical Practices and Patient Outcomes

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Measures of Multimorbidity and Morbidity Burden for Use in Primary Care and Community Settings: A Systematic Review and Guide

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Huntley, A. L., Johnson, R., Purdy, S., Valderas, J. M., Salisbury, C.·2012·The Annals of Family Medicine

DOI 10.1370/afm.1363PMC PMC3315139

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Abstract

PURPOSE: Many patients consulting in primary care have multiple conditions (multimorbidity). Aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and community populations, and to investigate their validity in relation to anticipated associations with patient characteristics, process measures, and health outcomes. METHODS: Studies were identified using searches in MEDLINE and EMBASE from inception to December 2009 and bibliographies. RESULTS: Included were 194 articles describing 17 different measures. Commonly used measures included disease counts (n = 98), Chronic Disease Score (CDS)/RxRisk (n = 17), Adjusted Clinical Groups (ACG) System (n = 25), the Charlson index (n = 38), the Cumulative Index Illness Rating Scale (CIRS; n = 10) and the Duke Severity of Illness Checklist (DUSOI; n = 6). Studies that compared measures suggest their predictive validity for the same outcome differs only slightly. Evidence is strongest for the ACG System, Charlson index, or disease counts in relation to care utilization; for the ACG System in relation to costs; for Charlson index in relation to mortality; and for disease counts or Charlson index in relation to quality of life. Simple counts of diseases or medications perform almost as well as complex measures in predicting most outcomes. Combining measures can improve validity. CONCLUSIONS: The measures most commonly used in primary care and community settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.

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Authors: Huntley, A. L., Johnson, R., Purdy, S., Valderas, J. M., & Salisbury, C.
Affiliations: University of Bristol (GB)
University of Oxford (GB)
ORCID: Huntley, A. L.
Johnson, R.
Purdy, S.
Valderas, J. M.
Salisbury, C.
Venue: The Annals of Family Medicine
Publisher: Annals of Family Medicine
Published: 2012-03-01
Volume: 10
Issue: 2
Pages: 134-141
ISSN: 1544-1709 (ISSN-L)
1544-1717
DOI: 10.1370/afm.1363
PMC: PMC3315139
OpenAlex: W2131863095
Cited by: 619
References: 72
Citations by year: 2026: 17 · 2025: 32 · 2024: 40 · 2023: 42 · 2022: 43 · 2021: 74 · 2020: 41 · 2019: 51 · 2018: 49 · 2017: 40 · 2016: 43 · 2015: 55 · 2014: 48 · 2013: 35 · 2012: 8
FWCI: 5.82
Type: journal article
Language: en
Open access: diamond
doi.org
Locations: The Annals of Family Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Explore Bristol Research (submittedVersion)
Bristol Research (University of Bristol) (submittedVersion)
Funders: National Institute for Health and Care Research (NIHR/CS/010/024, IAT/I-PF/009/011, CL-2010-25-005, SPCR-037)
Topics: Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: multimorbidity, disease burden, Charlson Comorbidity Index, Chronic Disease Score, Cumulative Illness Rating Scale, predictive validity, primary care, community population, health outcomes, mortality, quality of life, health care utilization, health care costs
MeSH terms: Community Health Services, Humans, Outcome and Process Assessment, Health Care, Primary Health Care, Comorbidity

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Measures of Multimorbidity and Morbidity Burden for Use in Primary Care and Community Settings: A Systematic Review and Guide

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