Healthcare task difficulty among older adults with multimorbidity

Cynthia M. Boyd, Jennifer L. Wolff, Erin Giovannetti, Lisa Reider, Carlos Orval Weiss, Qian Li Xue, Bruce Leff, Charles Boult, Travonia Hughes, Cynthia S Rand

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)S118-S125
JournalMedical care
Issue number3 SUPPL. 2
StatePublished - 2014


  • Comorbidity
  • Healthcare task difficulty
  • Multimorbidity
  • Treatment burden

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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