The Influence of Multimorbidity on Health Care Utilization at the End of Life for Patients with Chronic Conditions

Wagner, Elizabeth; Patrick, Donald L.; Brumback, Lyndia C.; Starks, Helene; Fausto, James A.; Dunlap, Benjamin; Lober, William B.; Sibley, James; Loggers, Elizabeth T.; Curtis, J. Randall; Engelberg, Ruth A.

doi:10.1089/jpm.2018.0349

Cited by 15 publications

(18 citation statements)

References 21 publications

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“…Similar to a previous study using this database, we found that a higher number of comorbidities was positively associated with higher health care use at EOL. 26 In addition, we found that patients with the highest comorbidity burden experienced the highest intensity of EOL health care use despite having more ACP documentation in their EHR. This may indicate that patients and families need additional support to provide out of hospital care, especially as death nears.…”

Section: Discussionmentioning

confidence: 72%

The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer

McDermott

Engelberg

Sibley

et al. 2020

Journal of Palliative Medicine

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Background: Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care, but their effect is not well explored in patients with cancer. Objective: We examined EOL health care intensity and advance care planning (ACP) documentation to better understand the association between MCCs and these outcomes. Design: Retrospective cohort study. Setting/Subjects: Patients aged 18+ years at UW Medicine who died during 2010-2017 with poor prognosis cancer, with or without chronic liver disease, chronic pulmonary disease, coronary artery disease, dementia, diabetes with end-stage organ damage, end-stage renal disease, heart failure, or peripheral vascular disease. Measurements: ACP documentation 30+ days before death, in-hospital death, and inpatient or intensive care unit (ICU) admission in the last 30 days. We performed logistic regression for outcomes. Results: Of 15,092 patients with cancer, 10,596 (70%) had 1+ MCCs (range 1-8). Patients with cancer and heart failure had highest odds of hospitalization (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.46-1.91), ICU admission (OR 2.06, 95% CI 1.76-2.41), or in-hospital death (OR 1.62, 95% CI 1.43-1.84) versus patients with cancer and other conditions. Patients with ACP 30+ days before death had lower odds of in-hospital death (OR 0.65, 95% CI 0.60-0.71), hospitalization (OR 0.67, 95% CI 0.61-0.74), or ICU admission (OR 0.71, 95% CI 0.64-0.80). Conclusions: Patients with ACP 30+ days before death had lower odds of high-intensity EOL care. Further research needs to explore how to best use ACP to ensure patients receive care aligned with patient and family goals for care.

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Section: Discussionmentioning

confidence: 72%

The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer

McDermott

Engelberg

Sibley

et al. 2020

Journal of Palliative Medicine

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“…An estimated 81% of adults aged 65 years and older in the United States have multiple chronic conditions (MCC), characterized by the presence of two or more chronic conditions in the same person. 1 Managing MCC is burdensome, both for the healthcare system and the individual; consequently, having MCC is associated with poor quality of life, 2 disability, 3 high health care utilization, 4 and high mortality. 5 Recent research suggests that certain chronic conditions may predictably co-occur, potentially due to common genetic, lifestyle and environmental propensities.…”

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confidence: 99%

Chronic condition clusters and associated disability over time

Klinedinst

Terhorst

Rodakowski

2022

Journal of Multimorbidity and Comorbidity

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Objectives Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (activities of daily living (ADL) and functional mobility (FM)) over time; the aim of this study was to investigate this relationship. Methods This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) ( n = 6179). Using latent class analysis (LCA), we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years. Results We identified six chronic condition clusters: Minimal Disease, Cognitive/Affective, Multiple Morbidity, Osteoporosis, Vascular, and Cancer. Chronic condition cluster was related to ADL and FM outcomes, indicating that groups experienced differential disability over time. At time point 4, all chronic condition groups had worse FM than Minimal Disease. Discussion The clusters of conditions identified here are plausible when considered clinically and in the context of previous research. All groups with chronic conditions carry risk for disability in FM and ADL; increased screening for disability in primary care could identify early disability and prevent decline.

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“…However, as 21 of these required additional data [ 6 , 25–44 ], we contacted the respective authors, and obtained eight responses [ 6 , 29 , 30 , 37 , 40 , 44 , 46 , 47 ]. Thus, 33 articles were included in this systematic review [ 11 , 12 , 27 , 34 , 54–82 ], of which 16 were included [ 12 , 27 , 34 , 54 , 56 , 58–60 , 64 , 68 , 69 , 71 , 74 , 77–79 ] in the meta-analysis ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis

et al. 2022

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Background Multimorbidity is defined as the presence of multiple chronic conditions in the same individual. Multimorbidity is more prevalent in older adults and can lead to several adverse health outcomes. Methods We systematically reviewed evidence from observational studies to verify the association between multimorbidity and hospitalization in older adults. Furthermore, we also aimed to identify whether it changes according to gender, advanced age, institutionalization, and wealth of the country of residence. We searched the PubMed, Embase and Scopus databases from December 2020 to April 2021. The analysed outcomes were as follows: hospitalization, length of stay and hospital readmission. Results Of the 6,948 studies identified in the databases, 33 were included in this review. From the meta-analysis results, it was found that multimorbidity, regardless of the country’s wealth, was linked to hospitalization in older adults (OR = 2.52, CI 95% = 1.87–3.38). Both definitions of multimorbidity, ≥2 (OR = 2.35, 95% CI = 1.34–4.12) and ≥3 morbidities (OR = 2.52, 95% CI = 1.87–3.38), were associated with hospitalization. Regardless of gender, multimorbidity was associated with hospitalization (OR = 1.98, 95% CI = 1.67–2.34) and with readmission (OR = 1.07, 95% CI = 1.04–1.09). However, it was not possible to verify the association between multimorbidity and length of stay. Conclusions Multimorbidity was linked to a higher hospitalization risk, and this risk was not affected by the country’s wealth and patient’s gender. Multimorbidity was also linked to a higher hospital readmission rate in older adults. PROSPERO Registration (Registration number: CRD42021229328).

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The Influence of Multimorbidity on Health Care Utilization at the End of Life for Patients with Chronic Conditions

Cited by 15 publications

References 21 publications

The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer

The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer

Chronic condition clusters and associated disability over time

Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis

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