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Role of Multimorbidity and Patterns of Care in Patients with Acute and Chronic Conditions Open Access


Other title
Multimorbidity in chronic disease
Multimorbidity in acute disease
Type of item
Degree grantor
University of Alberta
Author or creator
Weir, Daniala, Leann
Supervisor and department
McAlister, Finlay (Faculty of Medicine)
Majumdar, Sumit (Faculty of Medicine)
Eurich, Dean (School of Public Health)
Examining committee member and department
Kaul, Padma (Faculty of Medicine)
Department of Public Health Sciences
Date accepted
Graduation date
Master of Science
Degree level
Evidence surrounding the role of multimorbidity in an acute care setting, as well as factors associated with improved health outcomes in this patient population, is significantly lacking. Therefore, the objectives of this program of research were to determine the role of multimorbidity on short term morbidity and mortality in patients managed for an acute event and to evaluate the relationship between continuity of care and multimorbidity on short term morbidity and mortality in patients at high risk of adverse outcomes. These objectives were achieved through two related studies. First, a prospective cohort study of 6000 patients with community- acquired pneumonia (CAP) was conducted to evaluate the impact of multimorbidity on 90-day death, hospital admission and emergency department (ED) visits. The results indicated that multimorbidity was common in a population of patients experiencing an acute event with one-third of all patients in our study having multimorbidity. Moreover, multimorbidity was independently associated with an increased risk of death, hospitalization, or return to ED within 90 days of discharge. Although multimorbidity is largely evaluated in patients with chronic conditions, the current research suggests that multimorbidity has a significant impact in acute conditions as well. Building upon these findings, the second study evaluated the potential role of continuity of care in mitigating the impact of multimorbidity in patients at high risk of adverse outcomes. Utilizing a retrospective cohort of almost 3000 patients with incident type 2 diabetes, a similar, independent association between better continuity of care and a lower risk of death or all-cause hospitalizations at 1 year, was observed for both patients with and without multimorbidity. Furthermore, similar to our previous study in acute care, multimorbidity was also associated with significant increased risk of adverse outcomes. Collectively, this research suggests that clinicians and health care systems need to implement strategies to mitigate the negative impact of multimorbidity on patients. A potentially effective approach to achieve this is to improve follow-up and optimize continuity of care. Although this approach is likely reasonable for both acute and chronic disease settings, further research is required to affirm these findings in acute settings. Regardless, when managing or making site-of-care decisions for patients in acute or chronic settings, more attention should be paid to comorbidities and multimorbid conditions a patient may have.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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