Measuring the Quality of Care for Older Adults With Multimorbidity: Results of the MULTIqual Project

Abstract

Background and objectives: Providing health care for older adults with multimorbidity is often complex, challenging, and prone to fragmentation. Although clinical decision making should take into account treatment interactions, individual burden, and resources, current approaches to assessing quality of care mostly rely on indicators for single conditions. The aim of this project was to develop a set of generic quality indicators for the management of patients aged 65 and older with multimorbidity that can be used in both health care research and clinical practice.

Research design and methods: Based on the findings of a systematic literature review and eight focus groups with patients with multimorbidity and their family members, we developed candidate indicators. Identified aspects of quality were mapped to core domains of health care to obtain a guiding framework for quality-of-care assessment. Using nominal group technique, indicators were rated by a multidisciplinary expert panel (n = 23) following standardized criteria.

Results: We derived 47 candidate quality indicators from the literature and 4 additional indicators from the results of the focus groups. The expert panel selected a set of 25 indicators, which can be assigned to the levels of patient factors, patient-provider communication, and context and organizational structures of the conceptual framework.

Discussion and implications: We developed a comprehensive indicator set for the management of multimorbidity that can help to highlight areas with potential for improving the quality of care and support application of multimorbidity guidelines. Furthermore, this study may serve as a blueprint for participatory designs in the development of quality indicators.

Keywords: Chronic care; Comorbidity; Patient-centered care; Primary care; Quality standard.

Figure 1.

Flowchart of indicator development and number of resulting quality indicators (QIs). ^aFurther details to be published separately (Schulze et al., 2022).

Figure 2.

Flowchart of systematic literature review.

Figure 3.

Conceptual framework of quality of health care for older adults with multimorbidity. Note: A guiding framework for categorizing quality indicators in relation to domains of care and different levels of influences that affect health care, adapted from Taplin et al. (2012).