Health‐Related Quality of Life and Functional Status Quality Indicators for Older Persons with Multiple Chronic Conditions

Dy, Sydney M.; Pfoh, Elizabeth R.; Salive, Marcel E.; Boyd, Cynthia M.

doi:10.1111/jgs.12555

Cited by 27 publications

(24 citation statements)

References 12 publications

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“…Approximately 57 million Americans had multiple chronic diseases in 2000 and the number is projected to be 81 million in 2020 (2). Such persons also exhibit rapid declines in health status and greater likelihood of disability (3,5,6,7,8). Co-occurrence of illnesses is also costly; 66% of total health care spending currently is for care of those Americans with multi-morbidity (9).…”

Section: Introductionmentioning

confidence: 99%

A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity

Suls

Green

Davidson

2016

Psychosomatic Medicine

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Multi-morbidity, the co-occurrence of multiple physical or psychological illnesses, is prevalent particularly among older adults. The number of Americans with multiple chronic diseases is projected to increase from 57 million in 2000 to 81 million in 2020. However, behavioral medicine and health psychology, while focusing on the co-occurrence of psychological/psychiatric disorders with primary medical morbidities, have historically tended to ignore the co-occurrence of primary medical comorbidities, such as diabetes and cancer, and their biopsychosocial implications. This approach may hinder our ecologically valid understanding of the etiology, prevention, and treatment of individual patients with multi-morbidity. In this selective review, we propose a heuristic biobehavioral framework for the etiology of multi-morbidity. More acknowledgment and systematic research on multiple, co-existing disorders in behavioral medicine is consistent with the biopsychosocial model’s emphasis on treating the “whole person,” which means not considering any single illness, its symptoms, risk factors, or mechanisms, in isolation. As systems analytics, big data, machine learning, and mixed model trajectory analyses, among others, come on-line and become more widely available, we may be able to tackle multi-morbidity more holistically, efficiently and satisfactorily.

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Section: Introductionmentioning

confidence: 99%

A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity

Suls

Green

Davidson

2016

Psychosomatic Medicine

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“…Organizations, such as the American Heart Association, strongly advocate for the use of patient‐reported FS in clinical care . However, routine assessment of FS in clinical settings is subject to availability of validated, nonproprietary instruments, which can be easily incorporated into electronic health record platforms . A first step in that direction is a set of recommendations for the development of FS quality metrics proposed by the Assistant Secretary for Planning and Evaluation and the Centers for Medicare & Medicaid Services .…”

Section: Discussionmentioning

confidence: 99%

“…With the rapidly increasing burden of chronic cardiovascular disease (CVD), primary and secondary prevention efforts require a multilevel approach at the patient and provider levels across the continuum of care. Assessment of functional status (FS) is critical to effective prevention and treatment of chronic disease conditions; however, requirements for documentation of FS in routine clinical practice are only now beginning to be implemented . In comparison to those with functional limitations, patients with high FS report greater adherence to guideline‐recommended medication regimens, possibly as a result of the healthy adherer effect, and are more likely to initiate and adhere to recommended rehabilitation programs .…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Disease and Patterns of Change in Functional Status Over 15 Years: Findings From the Atherosclerosis Risk in Communities (ARIC) Study

Kucharska‐Newton

Griswold

Howard

et al. 2017

JAHA

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BackgroundCardiovascular disease (CVD) is the leading cause of premature disability, yet few prospective studies have examined functional status (FS) among persons with CVD. Our aim was to examine patterns of change in FS prior to and after hospitalization for nonfatal myocardial infarction, stroke, and heart failure among members of the Atherosclerosis Risk in Communities (ARIC) study cohort.Methods and Results FS was assessed using a modified Rosow‐Breslau questionnaire administered during routine annual telephone interviews conducted from 1993 through 2007 among 15 277 ARIC study participants. An FS score was constructed as a summary measure of responses to questions about participants' ability to perform selected tasks of daily living (eg, walking half a mile, climbing stairs). Incidence of CVD was assessed through ARIC surveillance of hospitalized events. Rate of change in FS over time prior to and following a CVD event was examined using generalized estimating equations. A decline in FS was observed on average 2 years prior to a myocardial infarction hospitalization and on average 3 years prior to a stroke or heart failure hospitalization. FS post–myocardial infarction declined relative to pre‐event levels but improved to close to pre–myocardial infarction levels within 3 years. Decline in FS following incident heart failure and stroke remained over time. Observed patterns of change in FS did not differ appreciably by race or sex.ConclusionsThis study documents that a decline in FS precedes incidence of CVD‐related hospitalization by at least 2 years, providing a strong argument for routine preventative assessment of FS among older adults.

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“…To create a “level the playing field” quality measures must be risk-adjusted among providers who serve very different patients (48). However, providers have expressed concern about how well these measures can discriminate between providers and institutions with high and low quality of care (49). Our study adds to these concerns, since hospitals that serve patients from low NSES neighborhoods may be unfairly judged.…”

Section: Discussionmentioning

confidence: 99%

Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes

et al. 2017

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Objective To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS). Methods We studied 1,481patients hospitalized with ACS in Massachusetts and Georgia querying HRQoL via the mental and physical components of the SF-36 (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-months post-discharge. We categorized participants by tertiles of the Neighborhood Deprivation Index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual SES and clinical characteristics. Results Participants had mean age 61.3 (SD: 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months post-discharge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. Neighborhood SES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above. Conclusions Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual and neighborhood SES may unfairly penalize safety net hospitals.

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Health‐Related Quality of Life and Functional Status Quality Indicators for Older Persons with Multiple Chronic Conditions

Cited by 27 publications

References 12 publications

A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity

A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity

Cardiovascular Disease and Patterns of Change in Functional Status Over 15 Years: Findings From the Atherosclerosis Risk in Communities (ARIC) Study

Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes

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