Journal of General Internal Medicine

, Volume 22, Issue 8, pp 1206–1211 | Cite as

Measuring Quality of Care in Patients With Multiple Clinical Conditions: Summary of a Conference Conducted by the Society of General Internal Medicine

  • Rachel M. Werner
  • Sheldon Greenfield
  • Constance Fung
  • Barbara J. Turner


Performance measurement has been widely advocated as a means to improve health care delivery and, ultimately, clinical outcomes. However, the evidence supporting the value of using the same quality measures designed for patients with a single clinical condition in patients with multiple conditions is weak. If clinically complex patients, defined here as patients with multiple clinical conditions, present greater challenges to achieving quality goals, providers may shun them or ignore important, but unmeasured, clinical issues. This paper summarizes the proceedings of a conference addressing the challenge of measuring quality of care in the patient with multiple clinical conditions with the goal of informing the implementation of quality measurement systems and future research programs on this topic. The conference had three main areas of discussion. First, the potential problems caused by applying current quality standards to patients with multiple conditions were examined. Second, the advantages and disadvantages of three strategies to improve quality measurement in clinically complex patients were evaluated: excluding certain clinically complex patients from a given standard, relaxing the performance target, and assigning a greater weight to some measures based on the expected clinical benefit or difficulty of reaching the performance target. Third, the strengths and weaknesses of potential novel measures such change in functional status were considered. The group concurred that, because clinically complex patients present a threat to the implementation of quality measures, high priority must be assigned to a research agenda on this topic. This research should evaluate the impact of quality measurement on these patients and expand the range of quality measures relevant to the care of clinically complex patients.


performance measurement quality measures clinically complex patients 



The authors gratefully acknowledge Greg Pawlson for his assistance as a conference leader and Robert Centor for his comments on an earlier draft of this manuscript. Funding was provided by the American Board of Internal Medicine (ABIM) Foundation and the Commonwealth Fund.

Conflict of Interest

Dr. Greenfield has received grants for research from Pfizer and Novo-nordisk and honoraria from Pfizer. Dr. Fung has received research support from a grant from Pfizer. Dr. Turner has received a grant for research from Pfizer.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Rachel M. Werner
    • 1
    • 2
    • 3
    • 8
  • Sheldon Greenfield
    • 4
  • Constance Fung
    • 5
    • 6
    • 7
  • Barbara J. Turner
    • 2
    • 3
  1. 1.Center for Health Equity Research and PromotionPhiladelphiaUSA
  2. 2.Division of General Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Medicine and the Center for Health Policy ResearchUniversity of CaliforniaIrvineUSA
  5. 5.Division of General Internal MedicineVA Greater Los Angeles Healthcare SystemLos AngelesUSA
  6. 6.David Geffen School of Medicine at UCLALos AngelesUSA
  7. 7.RAND CorporationSanta MonicaUSA
  8. 8.PhiladelphiaUSA

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