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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 23; 334(7607): 1296–1297.
PMCID: PMC1895691
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Patients with complex needs get high quality care

Patients with multiple illnesses can be hard to manage, but that doesn't adversely affect their overall quality of care, according to a study from the US. Quite the opposite in fact.

In three separate US cohorts, patients had consistently better care as their number of comorbid conditions increased. The researchers defined quality by the proportion of recommended care processes received by each patient. The score went up significantly (by 1.7-2.2%) for each extra condition they had, up to a maximum of five. Beyond that, the data were too sparse to be conclusive.

Patients with complex illnesses had more consultations and more hospital admissions than those with a single diagnosis, which partly explained the better quality of care. Being cared for by a specialist may be another contributing factor. The positive association between complexity and quality of care was strongest for patients who had seen at least one specialist. But it remained positive even for patients who didn't.

These unexpected findings should reassure observers who worry that using quality indicators in incentive programmes, such as performance related pay, might penalise providers who care for patients with multiple comorbidities.


  • N Engl J Med 2007;356:2496-504

Articles from The BMJ are provided here courtesy of BMJ Publishing Group