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NIHR researchers develop new way to measure multimorbidity


Researchers at the NIHR School for Primary Care Research have developed a new score for measuring multiple long-term health conditions in patients in primary care.

The new Cambridge Multimorbidity Score is a transparent, simple measure of multimorbidity that can predict different outcomes in people with multiple conditions. The score could help people planning clinical services or allocating healthcare resources to respond to the needs of patients with multiple health conditions.

Multimorbidity is defined as having two or more long-term health conditions at the same time. Around a quarter of patients in primary care have multiple conditions.

The number of patients with multiple long-term conditions is going up as the population ages, putting pressure on primary and secondary care. This pressure is exacerbated, the researchers say, by policies that promote rapid access to GPs over longer consultations, and single disease guidelines and performance targets.

Multimorbidity scores provide a way to identify patients in the population who are most likely to benefit from a tailored approach to care, but are unlikely to have a direct role in individual patient care. Multimorbidity scores can also inform health policy decision making, including resource allocation.

This research, published in the Canadian Medical Association Journal (CMAJ), used primary care data from the UK Clinical Practice Research Database to identify 300,000 patients who had more than one of 37 health conditions that often occur together, such as hypertension, anxiety or depression, or painful conditions.

The researchers then modelled how these conditions affected three key patient outcomes: general practitioner visits, unplanned hospital admissions and death.

The new score they subsequently developed, which includes just 20 conditions, outperforms the most commonly used current measure, the Charlson index, in predicting these three outcomes. The score performed best at predicting mortality, particularly following adjustment for age and gender, and was weakest at predicting primary care consultations.

Study author Martin Roland, Emeritus Professor of Health Services Research at the University of Cambridge and an emeritus NIHR Senior Investigator, said: “The Cambridge Multimorbidity Score can be a useful predictor of future health care use, including primary care utilisation, emergency department visits and death.

“The score may be of considerable value for policy development and health care priority setting, providing accurate, easy-to-implement ways of optimising healthcare delivery to an aging population with multiple illnesses.”

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