Background Multimorbidity is defined as the presence of multiple chronic conditions in the
same individual. Multimorbidity is more prevalent in older adults and can lead to several …

Background Machine learning–enabled clinical information systems (ML-CISs) have the
potential to drive health care delivery and research. The Fast Healthcare Interoperability …

Importance Accountable care contracts hold physician groups financially responsible for the
quality and cost of health care delivered to patients. Focusing on clinically vulnerable …

Background Inflammatory bowel disease (IBD) is a heterogeneous chronic inflammatory
condition requiring significant healthcare expenditure. Subgroups of individuals contribute …

Objective: To identify unplanned emergency resource utilization in the perioperative period
following bariatric surgery. Summary of Background Data: Avoidable emergency department …

Background Super-utilizers with 4 or more admissions per year frequently receive low-
quality care and disproportionately contribute to healthcare costs. Inpatient care …

Background: The 2016 President's Cancer Panel Connected Health report calls for
thoroughly characterizing the team structures and processes involved in coordinating care …

Background Care plans are central to effective care delivery for people with multiple chronic
conditions. But existing care plans—which typically are difficult to share across care settings …

Background Patients with complex chronic conditions experience fragmentation of care,
unnecessary hospitalization and reduced quality of life, with an increased incidence of poor …

Background Targeted care transitions programs may improve the value of hospital-based
health care. Super-utilizing patients with multiple chronic conditions (MCC) are thought to be …