1. Group I

2. Our Four Areas / Questions Identify patient preferred outcomes / goals and optimal communication methods to elicit unbiased and reliable outcome goals and patient preferences – Conduct CER studies using patient universal outcomes in addition to disease specific outcomes – Initiate a longitudinal study of variability of patient preferences over time. Determine the common biological characteristics of multiple co- morbidities and frailty – Eliminate the term “frailty”, measure walking speed, muscle strength, depression instead Describe the interaction of various morbidities with treatment effects and determine if there are mediators (e.g., depression) for individual morbidities and for a common set of morbidities. Determine the predictors of benefits / harms (heterogeneity). Evaluate the utility of a “health care coach” to improve care and patient universal outcomes.

3. Initiatives Use nurse practitioners to fill gaps in primary care Incorporate multiple morbidities in the training of all health care providers Create an agreed upon definition of multiple morbidities, outcome goals and preferences Incorporate more contextual factors into databases and registries used for research (i.e., SES, psychosocial, functional, cognitive, health literacy, and others). – Harold Proposal: Include these in Pinnacle Registry