Rising to the challenge of defining and operationalising multimorbidity in a UK hospital setting: the ADMISSION research collaborative

Abstract

Purpose Greater transparency and consistency when defining multimorbidity in different settings is needed. We aimed to: (1) adapt published principles that can guide the selection of long-term conditions for inclusion in research studies of multimorbidity in hospitals; (2) apply these principles and identify a list of long-term conditions; (3) operationalise this list by mapping it to International Classification of Diseases 10th revision (ICD-10) codes. Methods Review by independent assessors and ratification by an interdisciplinary programme management group. Results Agreement was reached that when defining multimorbidity in hospitals for research purposes all conditions must meet the following four criteria: (1) medical diagnosis; (2) typically present for ≥ 12 months; (3) at least one of currently active; permanent in effect; requiring current treatment, care or therapy; requiring surveillance; remitting-relapsing and requiring ongoing treatment or care, and; (4) lead to at least one of: significantly increased risk of death; significantly reduced quality of life; frailty or physical disability; significantly worsened mental health; significantly increased treatment burden (indicated by an increased risk of hospital admission or increased length of hospital stay). Application of these principles to two existing lists of conditions led to the selection of 60 conditions that can be used when defining multimorbidity for research focused on hospitalised patients. ICD-10 codes were identified for each of these conditions to ensure consistency in their operationalisation. Conclusions This work contributes to achieving the goal of greater transparency and consistency in the approach to the study of multimorbidity, with a specific focus on the UK hospital setting.

The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review

“…Work on specifying the conditions which should contribute to definitions of MLTC has progressed in recent years, with work by Ho et al. and the ADMISSION collaborative aiming to standardise definitions used across studies [ 5 , 169 ]. While a standardised methodology for delirium ascertainment remains challenging, optimising the assessment of delirium in research studies has been identified as an essential target to advance delirium practice and knowledge [ 170 ].…”