A Core Outcome Set for multimorbidity research (COSmm)

Susan M. Smith, Emma Wallace, Chris Salisbury, Maxime Sasseville, Elizabeth Bayliss, Martin Fortin

Research output: Contribution to journalArticle (Academic Journal)peer-review

84 Citations (Scopus)
281 Downloads (Pure)


To develop a consensus based set of core outcomes for studies in multimorbidity.

Consensus study following the COS-STAR guidelines for the design and reporting of core outcome sets. An expert Delphi Panel completed a web-based survey with two Rounds. Panellists were presented with a range of outcomes that had been identified in previous workshops and a related systematic review. They indicated their level of agreement on inclusion of each outcome using a Likert scale and outcomes reaching a pre-specified consensus level were included.

30 panellists were invited to participate and 26 agreed, from 13 countries. All 26 completed both rounds of the survey. The Delphi Panel reached consensus on 17 core outcomes for multimorbidity. The highest ranked outcomes were health related quality of life, mental health outcomes and mortality. Other outcomes were grouped into overarching themes of patient reported impacts and behaviours (treatment burden, self-rated health, self-management behaviour, self-efficacy, adherence); Physical activity and function (activities of daily living, physical function, physical activity); consultation related (communication, shared decision making, prioritisation); and health systems (healthcare utilisation, costs, quality of healthcare).

This consensus study involved a wide range of international experts who identified a large number of outcomes for multimorbidity intervention studies. The results suggest that quality of life, mortality and mental health outcomes should be regarded as essential core outcomes. However, researchers should also consider the full range of outcomes when designing studies to capture important domains in multimorbidity depending on individual study aims and interventions.
Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalAnnals of Family Medicine
Issue number2
Early online date27 Feb 2018
Publication statusPublished - Mar 2018


  • multimorbidity
  • chronic disease
  • complexity
  • methodology
  • primary care
  • research
  • core outcome set


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