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dc.contributor.author
Gassmann, Dimitri
dc.contributor.author
Cheetham, Marcus
dc.contributor.author
Siebenhuener, Klarissa
dc.contributor.author
Holzer, Barbara M.
dc.contributor.author
Meindl-Fridez, Claudine
dc.contributor.author
Hildenbrand, Florian F.
dc.contributor.author
Virgini, Vanessa
dc.contributor.author
Martin, Mike
dc.contributor.author
Battegay, Edouard
dc.date.accessioned
2018-01-30T14:36:00Z
dc.date.available
2018-01-25T13:03:55Z
dc.date.available
2018-01-30T14:36:00Z
dc.date.issued
2017
dc.identifier.other
10.1097/md.0000000000006144
en_US
dc.identifier.uri
http://hdl.handle.net/20.500.11850/234568
dc.identifier.doi
10.3929/ethz-b-000234568
dc.description.abstract
Therapeutic decision-making for patients with multimorbidity (MM) is challenging. Clinical practice guidelines inadequately address harmful interactions and resulting therapeutic conflicts within and among diseases. A patient-specific measure of MM severity that takes account of this conflict is needed. As a proof of concept, we evaluated whether the new Multimorbidity Interaction Severity Index (MISI) could be used to reliably differentiate patients in terms of lower versus higher potential for harmful interactions. Two hypothetical patient cases were generated, each with 6 concurrent morbidities. One case had a low (i.e., low conflict case) and the other a high (i.e., high conflict case) potential for harmful interactions. All possible interactions between conditions and treatments were extracted from each case's record into a multimorbidity interaction matrix. Experienced general internists (N = 18) judged each interaction in the matrix in terms of likely resource utilization needed to manage the interaction. Based on these judgements, a composite index of MM interaction severity, that is, the MISI, was generated for each physician and case. The difference between each physician's MISI score for the 2 cases (MISIdiff) was computed. Based on MISIdiff, the high conflict case was judged to be of significantly greater MM severity than was the low conflict case. The positive values of the inter-quartile range, a measure of variation (or disagreement) between the 2 cases, indicated general consistency of individual physicians in judging MM severity. The data indicate that the MISI can be used to reliably differentiate hypothetical multimorbid patients in terms of lesser versus greater severity of potentially harmful interactive effects. On this basis, the MISI will be further developed for use in patient-specific assessment and management of MM. The clinical relevance of the MISI as an alternative approach to defining MM severity is discussed.
en_US
dc.format
application/pdf
en_US
dc.language.iso
en
en_US
dc.publisher
Wolters Kluwer Health
en_US
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.subject
computerized decision support
en_US
dc.subject
drug–disease interactions
en_US
dc.subject
drug–drug interactions
en_US
dc.subject
MISI
en_US
dc.subject
multimorbidity
en_US
dc.subject
severity index
en_US
dc.subject
therapeutic conflict
en_US
dc.title
The multimorbidity interaction severity index (MISI)
en_US
dc.type
Journal Article
dc.rights.license
Creative Commons Attribution 4.0 International
ethz.journal.title
Medicine
ethz.journal.volume
96
en_US
ethz.journal.issue
8
en_US
ethz.pages.start
e6144
en_US
ethz.size
8 p.
en_US
ethz.version.deposit
publishedVersion
en_US
ethz.publication.place
Philadelphia, PA
en_US
ethz.publication.status
published
en_US
ethz.leitzahl
ETH Zürich::00002 - ETH Zürich::00003 - Schulleitung und Dienste::00030 - Bereich Rektorat / Domain Rectorate::02803 - Collegium Helveticum / Collegium Helveticum
en_US
ethz.leitzahl.certified
ETH Zürich::00002 - ETH Zürich::00003 - Schulleitung und Dienste::00030 - Bereich Rektorat / Domain Rectorate::02803 - Collegium Helveticum / Collegium Helveticum
en_US
ethz.date.deposited
2018-01-25T13:03:56Z
ethz.source
FORM
ethz.eth
no
en_US
ethz.availability
Open access
en_US
ethz.rosetta.installDate
2018-01-30T14:36:07Z
ethz.rosetta.lastUpdated
2018-01-30T14:36:07Z
ethz.rosetta.versionExported
true
ethz.COinS
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