Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Federal Initiatives on Multiple Chronic Conditions


The need to better understand how to care for individuals with multiple chronic conditions is a priority for the Department of Health and Human Services because of the growing size of the MCC cohort and the associated health care cost implications. In 2008, the HHS Office of the Assistant Secretary for Health launched an initiative to strengthen efforts directed at MCC, including establishment of the HHS Interagency Workgroup on MCC (Parekh et al., 2011). The Workgroup included representatives from key HHS Operating Divisions and Offices and was charged with identifying gaps in research and health care services for individuals with MCC. The Workgroup developed the HHS Strategic Framework on MCC (DHHS, 2010), a national roadmap for public and private stakeholders, and also produced and disseminated an annotated inventory of initiatives involving MCC. The Strategic Framework, published in December 2010, has four major goals:

  1. Fostering health care and public health system changes to improve the health of individuals with MCC.
  2. Maximizing the use of proven self-care management and other services by individuals with MCC.
  3. Providing better tools and information to health care, public health, and social services workers who deliver care to individuals with MCC.
  4. Facilitating research to fill knowledge gaps about, and interventions and systems to benefit, individuals with MCC.

For each goal there are subsets of objectives and action strategies for HHS, healthcare providers, and other stakeholders. The updated inventory of HHS MCC-related activities, programs, and initiatives, released in 2011, contains information on over 100 projects and studies organized according to the four goals, with web links for users (DHHS, 2011). The MCC Strategic Framework has helped to focus and align the activities of HHS agencies, and many agencies have initiatives that contribute to the four goals. It is important to note that there are a number of important research initiatives and collaborations currently underway that will produce findings and new analytic methods that will greatly shape MCC research moving forward. For example, the Agency for Healthcare Research and Quality’s (AHRQ) created the MCC Research Network, a collaborative of researchers from across the country conducting foundational research to improve our understanding of how to best study and treat MCC patients (AHRQ, 2013). The network includes 45 research teams with grants as follows:

  • Eighteen exploratory and developmental R21 grants funded in 2008 to address the gaps in knowledge related to MCC patients and preventive services.
  • Thirteen infrastructure development R24 grants funded in 2010 to develop new databases and information systems study MCC patients.
  • Fourteen exploratory R21 grants funding in 2010 to conduct comparative effectiveness research using currently available data.

Although we do not focus on the current federal initiatives in-progress, the methodological challenges and considerations discussed in the white paper can be applied to all types of MCC research, including both past and future efforts.

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