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Med Care. 2014 Mar;52 Suppl 3:S7-S14. doi: 10.1097/MLR.0000000000000045.

A conceptual model of the role of complexity in the care of patients with multiple chronic conditions.

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*Department of Health Services, University of Washington †MacColl Center for Healthcare Innovation, Group Health Research Institute, Seattle, WA ‡Denver Health and Hospital Authority, Denver, CO §Palo Alto Medical Foundation Research Institute, Palo Alto, CA ∥Agency for Healthcare Research and Quality, Center for Primary Care, Prevention, and Clinical Partnerships, Rockville, MD ¶Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford #Abt Associates, Cambridge, MA.



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.


To synthesize methodological and topical issues relevant to MCC patient care into a framework that can improve the delivery of care and advance future research about caring for patients with MCC.


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.

[Indexed for MEDLINE]

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