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Personas for People with Three or More Chronic Conditions

Personas for People with Three or More Chronic Conditions

Patient Segment: Individuals with Three or More Chronic Conditions

These patients are age 65 and older and have multiple (i.e., at least three) major chronic conditions, like diabetes, depression, or a heart condition. They may have a limited ability to do things like get out of bed, dress, or bathe themselves.


Struggling Sam: Sam lacks a strong social support system and has a poor relationship with his provider, leaving him feeling abandoned.

Coping Clare: With a strong social support system and an active coping style, Clare is able to manage her conditions and handle anxiety about her future.

High-Need Patients and the “Personas” Project

For patients with high needs — because of multiple chronic conditions, a limited ability to perform tasks like bathing or dressing, or other disabilities or conditions — health care can be challenging as well as extremely costly. Patients often report that their needs for care are unmet and that they don’t communicate adequately with their providers. A Commonwealth Fund project interviewed dozens of patients to explore their experiences and how their struggles to find support has affected their lives and those of family caregivers. As part of this research, we developed “personas” for different segments of the high-need patient population, including the caregivers attend to them. A persona is a tool that helps depict the experiences, motivations, and goals of a specific population – as well as the barriers they face. It helps to put a human face and voice on a patient population that is all too often seen only through a lens of clinical or cost data. Personas can help identify gaps in care or processes and can aid health systems in addressing these flaws.

Publication Details



Tanya Shah, et. al, "Personas for People with Three or More Chronic Conditions," Commonwealth Fund, January 18, 2019.