Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study

• Published in: BMC health services research Vol. 19; no. 1; p. 708
• Main Authors: Aubert, Carole E, Fankhauser, Niklaus, Marques-Vidal, Pedro, Stirnemann, Jérôme, Aujesky, Drahomir, Limacher, Andreas, Donzé, Jacques
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17-10-2019; BioMed Central; BMC
• Subjects: Aged; Analysis; Cardiovascular disease; Chronic Disease - epidemiology; Chronic Disease - therapy; Chronic diseases; Chronic illnesses; Chronic kidney failure; Cohort analysis; Combinations; Comorbidity; Female; Health services; Health services utilization; Hospital patients; Hospitals; Humans; Hypotheses; Internal medicine; Kidney diseases; Kidney failure; Length of stay; Male; Medical care utilization; Medicine; Middle Aged; Multimorbidity; Patient Acceptance of Health Care - statistics & numerical data; Potentially avoidable readmission; Readmission; Retrospective Studies; Switzerland - epidemiology; Switzerland; United States > US; Potentially avoidable readmission; Comorbidity; Combinations; Chronic diseases; Readmission; Healthcare utilization; Length of stay; Multimorbidity
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-019-4575-2

Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients.
We performed a multicentre retrospective cohort study including 33,871 multimorbid (≥2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010-2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques.
Three-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for ≥10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for ≥10 chronic diseases).
Multimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.