Defining Multimorbidity in Older Patients Hospitalized with Medical Conditions

Background The term “multimorbidity” identifies high-risk, complex patients and is conventionally defined as ≥2 comorbidities. However, this labels almost all older patients as multimorbid, making this definition less useful for physicians, hospitals, and policymakers. Objective Develop new medical...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2023-05, Vol.38 (6), p.1449-1458
Main Authors: Jain, Siddharth, Rosenbaum, Paul R., Reiter, Joseph G., Ramadan, Omar I., Hill, Alexander S., Hashemi, Sean, Brown, Rebecca T., Kelz, Rachel R., Fleisher, Lee A., Silber, Jeffrey H.
Format: Article
Language:English
Subjects:
Aged
Comorbidity
Congestive heart failure
Government programs
Heart Failure - epidemiology
Heart Failure - therapy
Hospitalization
Hospitals
Humans
Inpatients
Internal Medicine
Medicare
Medicine
Medicine & Public Health
Mortality
Myocardial infarction
Myocardial Infarction - epidemiology
Myocardial Infarction - therapy
Original Research
Patient Readmission
Patients
Physicians
Pneumonia
Pneumonia - epidemiology
Pneumonia - therapy
Risk
United States - epidemiology
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Summary:Background The term “multimorbidity” identifies high-risk, complex patients and is conventionally defined as ≥2 comorbidities. However, this labels almost all older patients as multimorbid, making this definition less useful for physicians, hospitals, and policymakers. Objective Develop new medical condition-specific multimorbidity definitions for patients admitted with acute myocardial infarction (AMI), heart failure (HF), and pneumonia patients. We developed three medical condition-specific multimorbidity definitions as the presence of single, double, or triple combinations of comorbidities — called Qualifying Comorbidity Sets (QCSs) — associated with at least doubling the risk of 30-day mortality for AMI and pneumonia, or one-and-a-half times for HF patients, compared to typical patients with these conditions. Design Cohort-based matching study Participants One hundred percent Medicare Fee-for-Service beneficiaries with inpatient admissions between 2016 and 2019 for AMI, HF, and pneumonia. Main Measures Thirty-day all-location mortality Key Results We defined multimorbidity as the presence of ≥1 QCS. The new definitions labeled fewer patients as multimorbid with a much higher risk of death compared to the conventional definition (≥2 comorbidities). The proportions of patients labeled as multimorbid using the new definition versus the conventional definition were: for AMI 47% versus 87% ( p value
ISSN:0884-8734
1525-1497
1525-1497
DOI:10.1007/s11606-022-07897-4