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A Conceptual Model of the Role of Complexity in the Care of Patients With Multiple Chronic Conditions

David Grembowski, Judith Schaefer, Karin Johnson, Henry Fischer, Susan Moore, Ming Tai-Seale, Richard Ricciardi, James Fraser, Donald Miller, Lisa LeRoy


July 9, 2014
Effective healthcare for people with multiple chronic conditions (MCC) is a US priority, but the inherent complexity makes both research and delivery of care particularly challenging. As part of AHRQ Multiple Chronic Conditions Research Network (MCCRN) efforts, the Network developed a conceptual model to guide research in this area.The Network synthesized essential constructs for MCC research identified from roundtable discussion, input from expert advisors, and previously published models.

The AHRQ MCCRN conceptual model defines complexity as the gap between patient needs and healthcare services, taking into account both the multiple considerations that affect the needs of MCC patients, as well as the contextual factors that influence service delivery. The model reframes processes and outcomes to include not only clinical care quality and experience, but also patient health, well being, and quality of life. The single-condition paradigm for treating needs one-by-one falls apart and highlights the need for care systems to address dynamic patient needs. Defining complexity in terms of the misalignment between patient needs and services offers new insights in how to research and develop solutions to patient care needs.