Multiple long-term conditions: multimorbidity register

Indicator

The practice can produce a register of people with multimorbidity who would benefit from a tailored approach to care.

Introduction

The NICE guideline on multimorbidity defines multimorbidity as two or more long-term health conditions that coexist independently in the same individual. NICE has developed a pragmatic definition of multimorbidity for the register using the presence of 4 or more condition categories which reflects an appraisal of international evidence, analysis of primary care data, and discussions with national academic, GP and clinical leads alongside the NICE Indicator Advisory Committee.

The indicator makes use of existing data to allow a register of people with multiple conditions to be constructed. For pragmatic reasons the register focuses on people with conditions in four or more of the categories. The conditions are based upon a cross-sectional study on the distribution of multimorbidity (Barnett et al. 2012). 

The register will support interventions that lead to improvement in health-related quality of life, care related decisions and patient safety and reduce adverse outcomes such as unplanned admissions.

Resource impact

The resource impact of the proposed indicator is unlikely to be significant. Expert opinion was that although the patient numbers with multimorbidity would be high, eligible patients would already be engaging regularly with their GP practices. Producing the register will therefore not impact on workload significantly.

There may some costs associated with providing a tailored assessment of comorbidities. Potential savings may be achieved by better managing comorbidities and establishing better control.