Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity Among Acutely Hospitalized Medical Patients (≥65 Years) – A Latent Class Approach

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Purpose

The majority of acutely admitted older medical patients are multimorbid, receive multiple drugs, and experience a complex treatment regime. To be able to optimize treatment and care, we need more knowledge of the association between different patterns of multimorbidity and healthcare utilization and the complexity thereof. The purpose was therefore to investigate patterns of multimorbidity in a Danish national cohort of acutely hospitalized medical patients aged 65 and older and to determine the association between these multimorbid patterns with the healthcare utilization and complexity.

Patients and Methods

Longitudinal cohort study of 129,900 (53% women) patients. Latent class analysis (LCA) was used to develop patterns of multimorbidity based on 22 chronic conditions ascertained from Danish national registers. A latent class regression was used to test for differences in healthcare utilization and healthcare complexity among the patterns measured in the year leading up to the index admission.

Results

LCA identified eight distinct multimorbid patterns. Patients belonging to multimorbid patterns including the major chronic conditions; diabetes and chronic obstructive pulmonary disease was associated with higher odds of healthcare utilization and complexity than the reference pattern (“Minimal chronic conditions”). The pattern with the highest number of chronic conditions did not show the highest healthcare utilization nor complexity.

Conclusion

Our study showed that chronic conditions cluster together and that these patterns differ in healthcare utilization and complexity. Patterns of multimorbidity have the potential to be used in epidemiological studies of healthcare planning but should be confirmed in other population-based studies.

Related collections

Most cited references 39

Record: found
Abstract: found
Article: not found

Recovery of activities of daily living in older adults after hospitalization for acute medical illness.

Cynthia M Boyd, C. Seth Landefeld, Steven Counsell … (2008)

To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge. Observational. Tertiary care hospital, community teaching hospital. Older (aged >or=70) patients nonelectively admitted to general medical services (1993-1998). Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point. By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover. For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.

0 comments Cited 206 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity.

Lloyd D. Hughes, Marion McMurdo, Bruce Guthrie (2013)

currently one of the major challenges facing clinical guidelines is multimorbidity. Current guidelines are not designed to consider the cumulative impact of treatment recommendations on people with several conditions, nor to allow comparison of relative benefits or risks. This is despite the fact that multimorbidity is a common phenomenon. to examine the extent to which National Institute of Health and Clinical Excellence (NICE) guidelines address patient comorbidity, patient centred care and patient compliance to treatment recommendations. five NICE clinical guidelines were selected for review (type-2 diabetes mellitus, secondary prevention for people with myocardial infarction, osteoarthritis, chronic obstructive pulmonary disease and depression) as these conditions are common causes of comorbidity and the guidelines had all been produced since 2007. Two authors extracted information from each full guideline and noted the extent to which the guidelines accounted for patient comorbidity, patient centred care and patient compliance. The cumulative recommended treatment, follow-up and self-care regime for two hypothetical patients were then created to illustrate the potential cumulative impact of applying single disease recommendations to people with multimorbidity. comorbidity and patient adherence were inconsistently accounted for in the guidelines, ranging from extensive discussion to none at all. Patient centred care was discussed in generic terms across the guidelines with limited disease-specific recommendations for clinicians. Explicitly following guideline recommendations for our two hypothetical patients would lead to a considerable treatment burden, even when recommendations were followed for mild to moderate conditions. In addition, the follow-up and self-care regime was complex potentially presenting problems for patient compliance. clinical guidelines have played an important role in improving healthcare for people with long-term conditions. However, in people with multimorbidity current guideline recommendations rapidly cumulate to drive polypharmacy, without providing guidance on how best to prioritise recommendations for individuals in whom treatment burden will sometimes be overwhelming.

0 comments Cited 188 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study

Caroline Bähler, Carola A Huber, Beat Brüngger … (2015)

Background Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors. Methods The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency. Results Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient. Conclusions Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.

0 comments Cited 186 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Clin Epidemiol

Journal ID (iso-abbrev): Clin Epidemiol

Journal ID (publisher-id): CLEP

Journal ID (pmc): clinepid

Title: Clinical Epidemiology

Publisher: Dove

ISSN (Electronic): 1179-1349

Publication date (Electronic): 28 February 2020

Publication date Collection: 2020

Volume: 12

Pages: 245-259

Affiliations

[1 ]Clinical Research Centre, Copenhagen University Hospital Hvidovre , Hvidovre, Denmark

[2 ]Department of Clinical Medicine, University of Copenhagen , Copenhagen, Denmark

[3 ]Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre , Hvidovre, Denmark

[4 ]Research Unit for General Practice , Aarhus, Denmark

[5 ]Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre , Hvidovre, Denmark

[6 ]Emergency Department, Copenhagen University Hospital Hvidovre , Hvidovre, Denmark

[7 ]Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg , Copenhagen, Denmark

[8 ]Section of Biostatistics, Department of Public Health, University of Copenhagen , Copenhagen, Denmark

Author notes

Correspondence: Helle Gybel Juul-Larsen Clinical Research Centre, Section 056, Copenhagen University, Amager and Hvidovre Hospitals , Kettegård Allé 30, HvidovreDK-2650, DenmarkTel +45 38626077 Email helle.juul-larsen@regionh.dk

Author information

Line Due Christensen http://orcid.org/0000-0002-4801-4335

Thomas Bandholm http://orcid.org/0000-0001-6884-1971

Thomas Kallemose http://orcid.org/0000-0002-7356-6481

Lillian Mørch Jørgensen http://orcid.org/0000-0002-0199-1577

Janne Petersen http://orcid.org/0000-0001-7323-2548

Article

Publisher ID: 226586

DOI: 10.2147/CLEP.S226586

PMC ID: 7053819

PubMed ID: 32184671

SO-VID: 18f7df1a-b931-4ab4-8f61-c904721fb825

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 09 August 2019

Date accepted : 12 November 2019

Page count

Figures: 4, Tables: 4, References: 65, Pages: 15

Comments

Comment on this article

scite_

Cited by 24

See all cited by

Most referenced authors 767

See all reference authors

Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity Among Acutely Hospitalized Medical Patients (≥65 Years) – A Latent Class Approach

Read this article at

Abstract

Purpose

Patients and Methods

Results

Conclusion

Related collections

Global Health Next Generation Network

Most cited references 39

Recovery of activities of daily living in older adults after hospitalization for acute medical illness.

Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity.

Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 209

Cited by 24

Most referenced authors 767