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Opportunities and challenges for patient-reported outcome assessment in multimorbidity research and practice

Nature Medicine (2024)Cite this article

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Multimorbidity, the cooccurrence of two or more chronic health conditions within the same individual, is increasingly prevalent worldwide and is associated with decreased health-related quality of life, increased mortality, and greater healthcare utilization1,2. The clinical care of multimorbidity is complex, arising from potential interactions between conditions, treatment regimens and overlapping symptoms. The management of multimorbidity requires a person-centered and individual approach that considers the overall effects of several chronic conditions and prioritizes what is most important to patients3. Patient-reported outcomes (PROs) are self-reported assessments that provide valuable insights into how an individual feels and functions, and an important component of person-centered care. Here, we explore the value of PROs and challenges to their implementation in the context of multimorbidity management.

Globally, health and social care systems are struggling to meet the needs of aging populations burdened by multimorbidity. Originally designed to manage single diseases, these systems now face substantial challenges to provide adequate care for individuals with many conditions. This mismatch places considerable strain on healthcare resources, leading to heightened utilization of services. For example, studies of GP consultations in England found that 78% of consultations involved patients with multimorbidity and that up to two minutes extra was required for each co-existing condition per consultation, indicating that individuals with a greater number of long-term conditions need longer consultation times4,5. PROs, if collected remotely or in advance of primary-care consultations, could support more efficient identification and prioritization of patients’ needs, thereby helping to streamline GP workloads and reduce use of resources. The COVID-19 pandemic accelerated the implementation of information technology tools (such as Accurx in the UK’s National Health Service), meaning it is becoming increasingly feasible to collect PROs in primary-care settings.

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Authors and Affiliations

  1. Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Sarah E. Hughes, Nicola E. Anderson, Christel McMullan, Benjamin M. A. Hughes & Melanie Calvert

  2. National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK

    Sarah E. Hughes, Nicola E. Anderson & Melanie Calvert

  3. NIHR Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK

    Sarah E. Hughes, Christel McMullan & Melanie Calvert

  4. NIHR Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK

    Sarah E. Hughes, Nicola E. Anderson & Melanie Calvert

  5. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Nicola E. Anderson

  6. Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Eleanor Hathaway, Christel McMullan & Shamil Haroon

  7. Patient Partner, Birmingham, UK

    Philip Collis

  8. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    John Devin Peipert

Authors
  1. Sarah E. Hughes
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  2. Nicola E. Anderson
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  4. Christel McMullan
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  5. Benjamin M. A. Hughes
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  7. John Devin Peipert
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  8. Shamil Haroon
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  9. Melanie Calvert
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Corresponding author

Correspondence to Sarah E. Hughes.

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Competing interests

S.E.H. receives funding from the National Institute of Health and Care Research (NIHR), NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, NIHR Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Centre (ARC) West Midlands, UKRI and UK SPINE. She declares personal fees from Cochlear, Pfizer, Rinri Therapeutics, Astra Zeneca, Aparito and CIS Oncology outside of the submitted work. M.J.C. is director of the Birmingham Health Partners Centre for Regulatory Science and Innovation, director of the Centre for the Centre for Patient Reported Outcomes Research and is an NIHR senior investigator. M.J.C. receives funding from the NIHR, UK Research and Innovation (UKRI), NIHR BRC, the NIHR Surgical Reconstruction and Microbiology Research Centre, NIHR ARC West Midlands, UK SPINE, European Regional Development Fund – Demand Hub and Health Data Research UK at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Innovate UK (part of UKRI), Macmillan Cancer Support, UCB Pharma, Janssen, GSK and Gilead. M.C. has received personal fees from Astellas, Aparito, CIS Oncology, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK and the Patient-Centered Outcomes Research Institute (PCORI) outside of the submitted work. In addition, a family member owns shares in GSK. N.A. receives funding from NIHR ARC West Midlands. C.M. receives funding from NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), UKRI, NIHR, NIHR BTRU in Precision Transplant and Cellular Therapeutics, and declares personal fees from Aparito outside of the submitted work. No other disclosures were reported.

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Hughes, S.E., Anderson, N.E., Hathaway, E. et al. Opportunities and challenges for patient-reported outcome assessment in multimorbidity research and practice. Nat Med (2024). https://doi.org/10.1038/s41591-024-03237-7

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