Healthcare task difficulty among older adults with multimorbidity

Background: Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. Objectives: To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. Research Design: Cross-sectional and longitudinal secondary data analysis. Subjects: Multimorbid adults aged 65 years or older from primary care clinics. Measures: We generated a scale (0-16) of self-reported difficulty with 8 HCTD and conducted factor analysis to assess its dimensionality and internal consistency. To assess predictive ability, cross-sectional associations of HCTD and number of chronic diseases, and conditions that add to health status complexity (falls, visual, and hearing impairment), patient activation, patient-reported quality of chronic illness care (Patient Assessment of Chronic Illness Care), mental and physical health (SF-36) were tested using statistical tests for trend (n = 904). Longitudinal analyses of the effects of change in HCTD on changes in the outcomes were conducted among a subset (n = 370) with Z1 follow-up at 6 and/or 18 months. All models were adjusted for age, education, sex, race, and time. Results: Greater HCTD was associated with worse mental and physical health [Cuzick test for trend (P < 0.05)], and patient-reported quality of chronic illness care (P< 0.05). In longitudinal analysis, increasing patient activation was associated with declining HCTD over time (P< 0.01). Increasing HCTD over time was associated with declining mental (P < 0.001) and physical health (P= 0.001) and patient-reported quality of chronic illness care (P < 0.05). Conclusions: The findings of this study establish the construct validity of the HCTD scale.