The American Geriatrics Society (AGS) is requesting support from the Agency for Healthcare Research and Quality to develop and disseminate the Multimorbidity Guiding Principles App (MGP app) that is based on our current efforts to address one of the greatest challenges in clinical care of older adults which is providing optimal care for frail elders with multiple chronic conditions, or "multimorbidity."1-4 Over 50% of older adults have three or more chronic diseases. The heterogeneous patterns and severity of conditions produce distinctive cumulative effects for each individual.5 In 2011, AGS convened an expert panel to address this pressing clinical need. The group has developed an approach to managing patients with multimorbidity, one that is built on a firm understanding of the principles of evidence-based medicine, patient preferences and goals of care, clinically feasible methods for understanding prognosis, and the multi-factorial geriatric issues and syndromes that may be consequences of the combinations of diseases and conditions (e.g., polypharmacy). Expert panel members were AGS leaders who specialize in the care of the medically complex older adult and the Guiding Principles reflect both invited expert peer review and public comment. In July 2012, we will be publishing our Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians (Multimorbidity Guiding Principles or MGP). In this proposal, we are seeking funding from Agency for Healthcare Research and Quality (AHRQ) to develop a multi-platform application (app) for smartphones and tablets that is based on our MGP and that draws upon the AHRQ National Guideline Clearinghouse in order to provide clinicians with best available evidence-based practice for the diseases and disorders of older adults. We are also seeking funding to diffuse the app to physicians specializing in Physical Medicine &Rehabilitation (PM&R) and Orthopaedic Surgery (OS) as a primary audience for this proposal so that we may better understand mechanisms for reaching medical and surgical specialties with this type of information. Our overarching goals for the proposed project are: Provide clinicians with guidance on how to resolve conflicting guideline recommendations when caring for older adults with multimorbidity. Promote awareness and adoption of our guiding principles among PM&R and OS specialists with the goal of improving care for patients with multimorbidity. Identify the most successful strategies for reaching medical and surgical specialists with the goal of rolling our tools out to all specialty physicians. During the three-yer project, we will be undertaking the following activities to advance this work: Developing a multiplatform app for smartphones and tablets that is based on our MPG and developing a portfolio of educational tools that support physicians who want to improve their care of this patient population. Identifying and training champions who will disseminate the MPG app to PM&R and OS using a variety of educational and communications tools. Creating and implementing a multi-faceted communications plan that is targeted to PM&R and OS and that takes advantage of traditional and social media communications channels. Evaluating the project, including overall success of our outreach efforts to promote awareness, tracking usage of the MGP App &Online Educational Tools, and the overall feedback on the MGP app as well as an evaluation of its effectiveness
Over 50% of older adults have three or more chronic diseases. Multimorbidity is associated with many adverse consequences, including death, disability, and institutionalization, increased utilization of healthcare resources, decreased quality of life, and higher rates of adverse effects of treatment or interventions. Comprehensive strategies for healthcare delivery that are not disease-specific, as well as interventions which target geriatric syndromes common in older adults with multimorbidity, show promise for this population.