Abstract
To validate the estimates of the prevalence of multimorbidity based on administrative hospital discharge data, with medical records and chart reviews as benchmarks. Retrospective cohort study. Medical division of a tertiary care teaching hospital. A total of 170 medical inpatients admitted from the emergency unit in January 2009. The prevalence of multimorbidity for three different definitions (≥2 diagnoses, ≥2 diagnoses from different ICD-10 chapters, and ≥2 medical conditions as defined by Charlson/Deyo) and three different data sources (administrative data, chart reviews, and medical records). The prevalence of multimorbidity in medical inpatients derived from administrative data, chart reviews and medical records was very high and concurred for the different definitions of multimorbidity (≥2 diagnoses: 96.5%, 95.3%, and 92.9% [p=0.32], ≥2 diagnoses from different ICD-10 chapters: 86.5%, 90.0%, and 85.9% [p = 0.46], and ≥2 medical conditions as defined by Charlson/Deyo: 48.2%, 50.0%, and 46.5% [p = 0.81]). The agreement of rating of multimorbidity for administrative data and chart reviews and administrative data and medical records was 94.1% and 93.0% (kappa statistics 0.47) for ≥2diagnoses; 86.0% and 86.5% (kappa statistics 0.52) for ≥2 diagnoses from different ICD-10 chapters; and 82.9% and 85.3% (kappa statistics 0.69) for ≥2 medical conditions as defined by Charlson/Deyo. Estimates of the prevalence of multimorbidity in medical inpatients based on administrative data, chart reviews and medical records were very high and congruent for the different definitions of multimorbidity. Agreement for rating multimorbidity based on the different data sources was moderate to good. Administrative hospital discharge data are a valid source for exploring the burden of multimorbidity in hospital settings.
Highlights
With continuous improvement in medical care and increasing longevity, a growing proportion of patients present to health care providers with multiple chronic co-existing diseases and conditions
Our results show a high prevalence of multimorbidity among patients admitted from the emergency unit to the medical ward of a tertiary care hospital, with a wide variation mainly due to the underlying definition
We found dissimilarities between the administrative data and medical records or chart reviews regarding the frequency of specific diagnoses, with a lower prevalence of anaemia, disorders of lipid metabolism, sleep disorders, hypertension, unspecified renal failure and drug allergy, and a higher prevalence of history of medical treatment and presence of grafts in the administrative data
Summary
With continuous improvement in medical care and increasing longevity, a growing proportion of patients present to health care providers with multiple chronic co-existing diseases and conditions (multimorbidity). The populationbased estimates of the prevalence of multimorbidity are between 20–30% for the entire population, and 55–98% for persons older than 65 years [8] Most studies reporting these estimates, especially those in primary care, used selfreports [1, 9,10,11] and general practitioners’ records [1, 4, 12, 13] as data sources. Studies from the United States and the Netherlands report prevalence rates of two or more chronic conditions in 22–65% of all inpatients [4, 14, 15] These estimates of multimorbidity among hospitalised patients were based on administrative data.
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