AHRQ Views: Blog posts from AHRQ leaders
AHRQ’s Role in Improving Care for Patients With Multiple Chronic Conditions
Recently, I was privileged to speak on a panel at the Commonwealth Fund’s International Symposium on Health Care Policy. It was an honor to share the stage with my distinguished co-panelists, ministers of health from several other Nations. We discussed the results of Commonwealth’s 2016 International Health Policy Survey of Adults in 11 Countries. This year’s survey focused on adults with multiple chronic conditions and complex care needs.
One finding that immediately jumped out at me was the 28 percent of adults in the United States who reported they have multiple chronic conditions—higher than that of any other country surveyed. This matters because care for patients with two or more chronic conditions, such as diabetes and asthma, is expensive. As an AHRQ chartbook (PDF File, 10.2 MB) has noted, approximately 71 percent of all health care spending in the United States goes toward treating these individuals.
Compounding the issue, Commonwealth’s results also indicate that, compared with the other countries in the survey, adults with multiple chronic conditions in the United States report the highest percentage of problems with care coordination. The complexity of these patients’ needs can overwhelm our capacity to organize services in a way which we can achieve optimal care.
My colleague Arlene Bierman, M.D., M.S., Director of AHRQ’s Center for Evidence and Practice Improvement, has some suggestions for how we might make some improvements in chronic care management. Arlene recently published an article in The Lancet in which she observes that clinical practice guidelines rarely provide the guidance necessary to optimize care for patients with multiple chronic conditions. But, she and her co-author describe a guideline from the United Kingdom’s National Institute for Health and Care Excellence (NICE) that might address this gap, because it helps clinicians identify patients who need complex care while providing a framework to deliver such care.
This is an important step forward. And, as Arlene points out, it is consistent with other important emerging resources on how to best manage patients with multiple chronic conditions. Some others include the following:
- AHRQ’s National Guideline ClearinghouseTM now tags guidelines, allowing users to identify those that address multiple chronic conditions.
- The American Geriatrics Society has produced a toolkit to support the management of multiple chronic conditions in older adults.
- AHRQ developed an Integration Playbook to guide practices in integrating behavioral health into primary care and other ambulatory care settings.
- AHRQ has also developed a care coordination quality measure for primary care and a measures atlas to help organizations assess how they’re doing.
- In addition, the Agency’s TeamSTEPPS® training tool can improve communication between primary care providers, specialists, and hospital discharge planners.
We have much to learn about how to structure and furnish health care services for individuals with multiple chronic conditions. And, we need to recognize that countries that perform better in coordinating care invest a higher proportion of their resources than we do in primary care. However, clinical guidelines focused on treating the whole patient, combined with improving the capacity of our primary care providers to better coordinate care, might help us to improve our performance. More importantly, it might result in better outcomes for a vulnerable group of patients.
I expect that this will be a major focus of health care public policy going forward, and AHRQ’s work continues to provide the evidence needed on how to deliver person-centered care that meets the needs of people with multiple chronic conditions. I believe AHRQ can continue to help lead this effort.