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

  • Author / Creator
    Weir, Daniala, Leann
  • 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.

  • Subjects / Keywords
  • Graduation date
    2014-11
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/R3KW57S3N
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Master's
  • Department
    • Department of Public Health Sciences
  • Specialization
    • Epidemiology
  • Supervisor / co-supervisor and their department(s)
    • Majumdar, Sumit (Faculty of Medicine)
    • Eurich, Dean (School of Public Health)
    • McAlister, Finlay (Faculty of Medicine)
  • Examining committee members and their departments
    • Kaul, Padma (Faculty of Medicine)