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February 5, 2021Swiss Medical WeeklyOpen Access

Association of in-hospital multimorbidity with healthcare outcomes in Swiss medical inpatients

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Key result

In-hospital multimorbidity was associated with significantly higher odds of in-hospital mortality (OR 1.31) compared to non-multimorbid cases among adult medical inpatients.

Why the study?

The association of multimorbidity with healthcare outcomes in hospitalised medical inpatients remains incompletely understood.

Does in-hospital multimorbidity increase the risk of adverse healthcare outcomes in adult medical inpatients?

Population

2,220,000 medical discharge records from 1,463,781 adult patients in Switzerland

Comparison

Multimorbidity (at least two chronic conditions) vs fewer than two chronic conditions

Design

Population-based cross-sectional study

Authors

MHMonika HuembelinCBCiril BaechliUWUlrich Wagner

Discussion

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Member takes

Overview

May flag higher-risk inpatients for monitoring; leaves open whether targeted interventions improve outcomes.

Study Design

Type

Cross-Sectional (n=2,220,000)

Multicenter

Yes

Structured PICO

Does in-hospital multimorbidity increase the risk of adverse healthcare outcomes in adult medical inpatients?

P
Population
2,220,000 adult medical inpatient discharge records from Swiss hospitals were analyzed to evaluate the association of multimorbidity with healthcare outcomes over a 6-year period.
E
Exposure
In-hospital multimorbidity (defined as the presence of at least two chronic conditions)
C
Comparator
Non-multimorbid cases (fewer than two chronic conditions)
O
Outcome
All-cause in-hospital mortalityhard clinical

Main Result

Odds Ratio: 1.31 (95% CI 1.28–1.34)

Absolute Event Rate: 5.5% vs 2.8%

p-value: p=<0.001

In-hospital multimorbidity is highly prevalent among medical inpatients and is significantly associated with increased in-hospital mortality, ICU admission, length of stay, and readmission rates, with the strongest associations observed in younger patients.

Limitations

  • Use of administrative data is prone to information bias, misclassification, and underreporting of diagnoses.
  • No information on out-of-hospital mortality available.
  • Lack of severity estimates for the hospitalized cases.
  • Non-experimental, observational design limits the ability to establish a causal link.
  • Unable to account for unmeasured residual confounding due to lack of clinical appearance and laboratory parameters.
  • Impact of the implementation of the Swiss-DRG reimbursement system on coding practices
  • Changes in coding habits of medical coders over the 6-year period
  • Physicians' heterogeneous awareness of multimorbidity
  • Analyses were not adjusted for the specific number or clusters of chronic conditions

Cite This Study

Huembelin et al. (2021) conducted a cross-sectional in In-hospital multimorbidity (n=2,220,000). Multimorbidity (≥2 chronic conditions) vs. Non-multimorbid cases (≤1 chronic condition) was evaluated on All-cause in-hospital mortality (OR 1.31, 95% CI 1.28 to 1.34, p=<0.001). In-hospital multimorbidity was associated with significantly higher odds of in-hospital mortality (OR 1.31) compared to non-multimorbid cases among adult medical inpatients.

synapsesocial.com/papers/6a9d742715f03e7590bf166chttps://doi.org/10.4414/smw.2021.20405
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Also Consider

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