The Conceptualization and Measurement of Comorbidity: A Review of the Interprofessional Discourse

Salimah H Meghani,Eneida Rejane Rabelo-Silva,Victoria Vaughan Dickson,Mary D Naylor,Harleah G Buck,Robyn Clark,Marilyn J Hammer

doi:10.1155/2013/192782

Abstract

Background. Chronic medical conditions often occur in combination. Understanding underlying mechanisms causing diseases and their interactions may make it possible to address multiple complex conditions with single or consolidated treatment approaches and improve patients' health outcomes while reducing costs. Objectives. We present a synthesis of the current interprofessional discourse on the issues surrounding comorbidities. Methods. A targeted review of the literature was conducted using published editorials, commentaries, and review articles. Results. Errors in conceptualization and measurement plague our current understanding of comorbidities. Two potential paths to generating knowledge involve the use of etiological or epidemiological approach. An etiological approach investigates the risk factors and underlying mechanisms potentially leading to consolidation of diagnosis and treatments. Because of the rudimentary stage of knowledge development in this area, this approach will require time and significant research investments. In contrast, the epidemiological approach relies on statistical identification of disease entities that cooccur beyond random chance; this approach carries an accompanying risk of diagnostic and treatment proliferation. Discussion. The concept of comorbidity, its nature, and measurement is in need of meaningful debate by the scientific and clinical communities. Recommendations in the domains of conceptualization, research, and measurement are discussed.

Highlights

Chronic medical conditions rarely occur in isolation but rather in combination, as comorbidities
Successful management of chronic conditions is associated with complex treatment regimens and requires adequate self-care by the patient of all comorbid conditions
The epidemiological approach requires identifying disease entities that cooccur beyond random chance

Summary

Introduction

Chronic medical conditions rarely occur in isolation but rather in combination, as comorbidities. Successful management of chronic conditions is associated with complex treatment regimens and requires adequate self-care by the patient of all comorbid conditions. Improving self-care among patients with chronic illness necessitates a better understanding of the complexities of comorbidity. Both research and clinical communities have begun to pay close attention to the complexity of comorbidities in an attempt to appreciate its scope and utility for enhancing practice and patient outcomes [7,8,9]. Understanding underlying mechanisms causing diseases and their interactions may make it possible to address multiple complex conditions with single or consolidated treatment approaches and improve patients’ health outcomes while reducing costs. An etiological approach investigates the risk factors and underlying mechanisms potentially leading to consolidation of diagnosis and treatments. Recommendations in the domains of conceptualization, research, and measurement are discussed

Objectives

Findings

Discussion

Conclusion