The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study

Gruneir, Andrea; Bronskill, Susan E.; Maxwell, Colleen J.; Bai, Yu; Koné, Anna Péfoyo; Thavorn, Kednapa; Petrosyan, Yelena; Calzavara, Andrew; Wodchis, Walter P.

doi:10.1186/s12913-016-1415-5

Cited by 121 publications

(144 citation statements)

References 26 publications

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“…Moreover, while the proportion of those with multimorbidity is generally higher at older ages, in some populations the absolute number of people affected by multimorbidity is greater among those under 65 years of age due to the age structure of the population. 85,86,87,88,89 Multimorbidity is not exclusive to older people, and appears to affect a much broader cross-section of the population. The data are taken from a systematic review of 39 observational studies across 12 HICs, and illustrate a well-established positive association between age and prevalence of multimorbidity.…”

Section: Descriptive Epidemiology: Prevalence and Incidencementioning

confidence: 99%

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

et al. 2020

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Background Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. Objective This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person’s Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. Results PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. Conclusions There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.

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Section: Descriptive Epidemiology: Prevalence and Incidencementioning

confidence: 99%

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

et al. 2020

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“…Ontario's health administrative data have been shown to be both valid and reliable, 20 and have been used previously to estimate medical costs 21 and study patterns of health services use. 18,[21][22][23][24][25]…”

Section: Setting and Datamentioning

confidence: 99%

The impact of hospital harm on length of stay, costs of care and length of person-centred episodes of care: a retrospective cohort study

Tessier

Guilcher

et al. 2019

CMAJ

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P atient safety is a key component of high-quality health care delivery as well as an expectation among patients and caregivers. Substantial interest in improving patient safety was prompted following the release of the Institute of Medicine's seminal report, To Err is Human, 1 which estimated that between 44 000 and 98 000 Americans died each year as a result of medical mistakes, with an associated cost between US$17 billion and $29 billion. The Canadian Adverse Events Study followed shortly thereafter and estimated that, in 2000, about 185 000 hospital admissions were associated with an adverse event, and close to 70 000 of these were potentially preventable. 2 Despite the substantial attention these findings generated and the policy initiatives they inspired, 3,4 hospital-based adverse events remain a prevalent issue. 5,6 Recently, the Canadian Institute for Health Information (CIHI) partnered with the Canadian Patient Safety Institute to develop a measure of adverse events in hospital-termed "hospital harm"-using administrative health data. 7 This measure is analogous to the Agency for Healthcare Research and Quality's Patient Safety Indicators 8,9 and enables a renewed attention on surveillance of patient safety specific to a Canadian setting. Although it is understood that experiencing harm in hospital increases length of hospital stay, 5,9,10 costs of hospital care, 9-17 risk of death 9,11,14 and risk of re-admission, 11,14 there is a lack of information on the relation between hospital harm and total cost inclusive of postdischarge use of health services and accompanying costs. 14 In this study, our objective was to assess the impact of hospital harm on the incremental length of hospital stay, as well as on RESEARCH HEALTH SERVICES

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“…Previous studies have shown better outcomes for HF patients cared for by physicians familiar with them after hospital discharges or emergency department visits. Other studies have also demonstrated that continuity of physician care reduces hospitalizations, especially for patients with high comorbidity burdens . Thus, it seems reasonable to hypothesize that continuity of inpatient care would be associated with improved outcomes—however, we acknowledge that this is a hypothesis that requires testing in a prospective, controlled study.…”

Section: Discussionmentioning

confidence: 76%

“…Although we acknowledge this weakness, we used validated International Classification of Diseases codes and data definition algorithms to build comorbidity profiles and the outcomes we evaluated (all‐cause rehospitalizations, LOS, and in‐hospital mortality) are relevant in HF patients regardless of ejection fraction, etiology, or clinical status. Second, although outpatient visits, particularly with familiar physicians or access to specialized clinics after discharge, would reduce readmissions, we do not have any data on whether availability of these outpatient resources varied over time or whether outpatient physician visits were or were not with physicians associated with the original hospital. Third, we had no data on distance from patient home to nearest hospital nor socioeconomic factors, such as homelessness or access to motor vehicle, that may have influenced both health outcomes and choice of hospital.…”

Section: Discussionmentioning

confidence: 99%

Patients With Heart Failure Readmitted to the Original Hospital Have Better Outcomes Than Those Readmitted Elsewhere

McAlister

Youngson

Kaul

2017

JAHA

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BackgroundUp to one fifth of readmissions after a heart failure hospitalization occur at a different hospital. This negatively impacts information continuity, but whether site of readmission impacts subsequent outcomes is unclear.Methods and ResultsRetrospective cohort study of all patients discharged with a primary diagnosis of heart failure in Canada between April 2004 and December 2013. We compared patients readmitted within 30 days to the original hospital versus a different hospital. Of the 217 039 heart failure patients (mean age, 76.8 years, 50.1% male), 39 368 (18.1%) were readmitted within 30 days—32 771 (83.2%) to the original hospital and 6597 (16.8%) to a different hospital (increasing over time from 15.6% in 2004 to 18.5% by 2013; P for trend=0.001). Patients readmitted to different hospitals were younger and were more likely to be male, have a rural residence, a more‐recent discharge year, an index hospitalization at a teaching hospital, and to be brought in by ambulance at the time of the readmission. Readmissions to the original hospital were substantially shorter (mean, 10.4 days [95% CI, 10.3–10.6] versus 11.6 days [95% CI, 11.3–12.0]; adjusted means, 11.0 versus 12.0; P<0.0001) and had lower mortality (14.4% versus 15.0%; adjusted odds ratio, 0.89; 95% CI, 0.82–0.96) than readmissions to different hospitals.ConclusionsReadmissions to a different hospital are becoming more frequent over time and are associated with longer stays and higher mortality rates than readmissions to the original hospital. Our findings provide further evidence that care fragmentation may be deleterious for patients with heart failure.

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The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study

Cited by 121 publications

References 26 publications

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

The impact of hospital harm on length of stay, costs of care and length of person-centred episodes of care: a retrospective cohort study

Patients With Heart Failure Readmitted to the Original Hospital Have Better Outcomes Than Those Readmitted Elsewhere

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