Issues Involved in the Definition and Classification of Chronic Health Conditions

Abstract

The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.

Impact of uncertainty associated with a child's chronic health condition on parents' health.

“…This study involved secondary analysis of data from Project Resilience (Dodgson et al, 2000; Garwick, Patterson, Meschke, Bennett, & Blum, 2002), a longitudinal study of families of 327 infants and preadolescents with a variety of chronic health conditions. Project Resilience used a noncategorical approach grounded in the premise that children and families living with a wide variety of chronic health conditions experience common stressors (Perrin et al, 1993; Stein, Bauman, Westbrook, Coupley, & Ireys, 1993). Research has supported this premise: The psychosocial impact of chronic conditions on children and families is more similar across conditions than different (Gartstein, Short, Vannatta, & Noll, 1999).…”

Marital satisfaction and mental health of couples with children with chronic health conditions.

“…Most researchers have used a disease-specific approach in studying the family's experience of caring for a child with a chronic health condition. The noncategorical approach used for Project Resilience was based on several investigators' observations that family psychosocial adjustment to many different childhood conditions may be similar, although other condition characteristics may differentially affect adjustment (Newacheck et al, 1998;Perrin et al, 1993;Stein et al, 1987;Stein et al, 1993). Institutional review board (IRB) approval was given for this study by the University of Minnesota, University of Washington, and the 13 hospitals and clinics from which the sample was drawn.…”

The measurement of multimorbidity.

“…Researchers interested in creating a list of chronic conditions may find that the seemingly simple designation of a disease or medical condition as chronic can be confusing without a consistent use of this classification term. The simplest definition of a chronic condition is based only on the condition’s duration (minimal time intervals of 3, 6, and 12 months have been suggested), but other criteria such as pattern of recurrence or deterioration, prognosis, consequences or sequelae, need for continuous medical treatment, prevalence, and onset have also been suggested (Diederichs et al, 2011; N′Goran et al, 2016; O’Halloran, Miller, & Britt, 2004; Perrin et al, 1993; Stein, Bauman, Westbrook, Coupey, & Ireys, 1993). In this sense, efforts have been made to standardize the definition of chronicity for use in research.…”