ReviewJournal of general internal medicine2014
A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity.
Review in Journal of general internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
89 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Sex as a prognostic factor for mortality in adults with acute symptomatic pulmonary embolism.The Cochrane database of systematic reviews · 2025Pooled it
- Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review.Global heart · 2022Pooled it
- Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review.Journal of the American Medical Directors Association · 2017Pooled it
- An integrated model of multimorbidity and symptom science.Nursing outlookPooled it
- Age-related differences in the presentation, management, and outcomes of lower gastrointestinal bleeding: a retrospective multinational cohort study.The Lancet regional health. Europe · 2026Article
- Quality of life among women of reproductive age during the accumulation of multiple chronic conditions.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026Article
- Revolutionizing Multimorbidity Care: A Narrative Review on Artificial Intelligence Applications.Health science reports · 2026Article
- Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors.Diagnostics (Basel, Switzerland) · 2026Review
- Making clinical guidelines work for people with multiple long term conditions: analysis and recommendations from review of single condition guidelines.BMJ medicine · 2026Article
- Clinical decision-making and care pathways for people with multiple long-term conditions admitted to hospital: a scoping review.BMJ open · 2025Article
- Article
- Integrating general practitioners' and patients' perspectives in the development of a digital tool supporting primary care for older patients with multimorbidity: a focus group study.Frontiers in digital health · 2025Article
- New horizons in clinical practice guidelines for use with older people.Age and ageing · 2024Article
- Is 'too much medicine' a guideline-driven phenomenon? Ten years' report and reflections of the Guidelines International Network Multimorbidity Working Group.Clinical and public health guidelines · 2024Article
- Multicentric Assessment of a Multimorbidity-Adjusted Disability Score to Stratify Depression-Related Risks Using Temporal Disease Maps: Instrument Validation Study.Journal of medical Internet research · 2024Article
- Trends in the Prevalence of Multiple Chronic Conditions Among US Adults With Hypertension From 1999-2000 Through 2017-2020.American journal of hypertension · 2024Article
- Trustworthy evidence-based versus untrustworthy guidelines: detecting the difference.Family medicine and community health · 2023Article
- Needs of multimorbid heart failure patients and their carers: a qualitative interview study and the creation of personas as a basis for a blended collaborative care intervention.Frontiers in cardiovascular medicine · 2023Article
- Hospitalization and emergency department visits associated with potentially inappropriate medication in older adults: self-controlled case series analysis.Frontiers in public health · 2023Article
- Multimorbidity and COVID-19 in Canada: How the Pandemic Has Highlighted a Key and Yet Underappreciated Risk Factor.Canadian geriatrics journal : CGJ · 2022Article
29 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
Abstract
Many patients of all ages have multiple conditions, yet clinicians often lack explicit guidance on how to approach clinical decision-making for such people. Most recommendations from clinical practice guidelines (CPGs) focus on the management of single diseases, and may be harmful or impractical for patients with multimorbidity. A major barrier to the development of guidance for people with multimorbidity stems from the fact that the evidence underlying CPGs derives from studies predominantly focused on the management of a single disease. In this paper, the investigators from the Improving Guidelines for Multimorbid Patients Study Group present consensus-based recommendations for guideline developers to make guidelines more useful for the care of people with multimorbidity. In an iterative process informed by review of key literature and experience, we drafted a list of issues and possible approaches for addressing important coexisting conditions in each step of the guideline development process, with a focus on considering relevant interactions between the conditions, their treatments and their outcomes. The recommended approaches address consideration of coexisting conditions at all major steps in CPG development, from nominating and scoping the topic, commissioning the work group, refining key questions, ranking importance of outcomes, conducting systematic reviews, assessing quality of evidence and applicability, summarizing benefits and harms, to formulating recommendations and grading their strength. The list of issues and recommendations was reviewed and refined iteratively by stakeholders. This framework acknowledges the challenges faced by CPG developers who must make complex judgments in the absence of high-quality or direct evidence. These recommendations require validation through implementation, evaluation and refinement.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.