Abstract
BackgroundMultimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients.MethodsWe performed a multicentre retrospective cohort study including 33,871 multimorbid (≥2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010–2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques.ResultsThree-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for ≥10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for ≥10 chronic diseases).ConclusionsMultimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.
Highlights
Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization
Combinations of comorbidities and prolonged length of stay Two combinations of comorbidities showed a particular high odds ratio (OR) for a prolonged LOS and a particular high difference in median LOS (Table 3): 1) miscellaneous mental health disorders combined with mood disorders (OR for prolonged LOS: 11.28, 95%confidence interval (CI) 8.71;14.61; difference in median LOS: 17.4 days, 95%CI 16.5;18.3); 2) diseases of white blood cells combined with hematological malignancy (OR for prolonged LOS: 10.95, 95%CI 9.06;13.24; difference in median LOS: 15.7 days, 95%CI 15.1;16.4)
Miscellaneous mental health disorders combined with mood disorders, and diseases of white blood cells combined with hematological malignancy, were strongly associated with a prolonged LOS
Summary
Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. Given its association with poor quality of life, functional decline and healthcare resource utilization, Potentially avoidable readmission (PAR) and length of stay (LOS) are two different and relatively simple measures of healthcare resource utilization among inpatients [7]. Given that both the rate of PAR and the LOS can be effectively reduced by various preventive but often complex and costly interventions, it is essential to identify patients at higher risk for PAR or prolonged LOS, in order to improve allocation of these interventions [8,9,10]. More complex effects of chronic comorbidities on the odds for PAR or prolonged LOS, such as interactions that may lead to more than multiplicative effects on this odds, have not yet been studied
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