Prevalence and overlap of Disease Management Program diseases in older hospitalized patients

Helle Gybel Juul-Larsen,Ove Andersen,Janne Petersen,Ditte Maria Sivertsen

doi:10.1007/s10433-017-0412-9

Helle Gybel Juul-Larsen, Ove Andersen + Show 2 more

Open Access

https://doi.org/10.1007/s10433-017-0412-9

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Abstract

Many countries, like Denmark, have tailored Disease Management Programs (DMPs) based on patients having single chronic diseases [defined institutionally as “program diseases” (PDs)], which can complicate treatment for those with multiple chronic diseases. The aims of this study were (a) to assess the prevalence and overlap among acutely hospitalized older medical patients of PDs defined by the DMPs, and (b) to examine transitions between different departments during hospitalization and mortality and readmission within two time intervals among patients with the different PDs. We conducted a registry study of 4649 acutely hospitalized medical patients ≥65 years admitted to Copenhagen University Hospital, Hvidovre, Denmark, in 2012, and divided patients into six PD groups (type 2 diabetes, chronic obstructive pulmonary disease, cardiovascular disease, musculoskeletal disease, dementia and cancer), each defined by several ICD-10 codes predefined in the DMPs. Of these patients, 904 (19.4%) had 2 + PDs, and there were 47 different combinations of the six different PDs. The most prevalent pair of PDs was type 2 diabetes with cardiovascular disease in 203 (22.5%) patients, of whom 40.4% had an additional PD. The range of the cumulative incidence of being readmitted within 90 days was between 28.8% for patients without a PD and 46.6% for patients with more than one PD. PDs overlapped in many combinations, and all patients had a high probability of being readmitted. Hence, developing strategies to create a new generation of DMPs applicable to older patients with comorbidities could help clinicians organize treatment across DMPs.

Highlights

The prevalence of chronic diseases increases with age and systematic reviews have found a prevalence of multimorbidity of up to 98% in persons aged 60 or older (Marengoni et al 2011; Fortin et al 2012)
In comparing patients with 2 ? program diseases (PDs) with the other groups, multinomial regression models showed that patients with the type 2 diabetes PD were younger than patients with 2 ? PDs and patients with the dementia PD were older than patients with 2 ? PDs
The risk of being registered with three or more International Classification of Diseases 10th edition (ICD-10) disease categories was significantly higher for patients with one or 2 ? PDs compared with patients not having a PD

Summary

Introduction

The prevalence of chronic diseases increases with age (van den Akker et al 1998; Fortin et al 2005; Denton and Spencer 2010) and systematic reviews have found a prevalence of multimorbidity (multiple chronic diseases) of up to 98% in persons aged 60 or older (Marengoni et al 2011; Fortin et al 2012). Patients with diseases in more than one organ system risk incoherent trajectories in association with the hospitalization because the coordination among different departments and different parts of the health service may be perceived as problematic To improve management of chronic diseases, the Danish Health and Medicines Authority has recommended Disease Management Programs (DMPs) tailored to Danish health care (Danish Health and Medicines Authority 2012a), similar to several other countries (Lugtenberg et al 2011). The DMPs are standardized descriptions of the multidisciplinary, multisectional, coordinated and evidence-based healthcare work. This work includes prevention, diagnosis, treatment, rehabilitation and follow-up, cooperation and coordination between the acute and primary care settings based on a specific patient group (Danish Health and Medicines Authority 2012a)

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