Assessing the Burden of Treatment

Abstract

Current healthcare systems and guidelines are not designed to adapt to care for the large and growing number of patients with complex care needs and those with multimorbidity. Minimally disruptive medicine (MDM) is an approach to providing care for complex patients that advances patients' goals in health and life while minimizing the burden of treatment. Measures of treatment burden assess the impact of healthcare workload on patient function and well-being. At least two of these measures are now available for use with patients living with chronic conditions. Here, we describe these measures and how they can be useful for clinicians, researchers, managers, and policymakers. Their work to improve the care of high-cost, high-use, complex patients using innovative patient-centered models such as MDM should be supported by periodic large-scale assessments of treatment burden.

Keywords: chronic disease; minimally disruptive medicine; multimorbidity; quality measures; treatment burden.

Figure 1

Cumulative Complexity Model (CuCoM). The model describes how clinical and social factors affect care in patients with chronic conditions and multimorbidity. Workload comprises patients’ life demands and healthcare demands with their associated burden of treatment. Capacity refers to patients’ resources and abilities. A balance between workload and capacity should support patients’ ability to access and use care and to enact self-care in order to achieve improved health outcomes. When patients experience poor health outcomes, the burden of illness increases, and the clinical response is often to intensify treatment. This combination can exacerbate workload/capacity imbalance, resulting in a cycle of deterioration. Sources: Shippee et al. (2012), Leppin et al. (2015).