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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study

Authors: Andrea Gruneir, Susan E. Bronskill, Colleen J. Maxwell, Yu Qing Bai, Anna J. Kone, Kednapa Thavorn, Yelena Petrosyan, Andrew Calzavara, Walter P. Wodchis

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Multimorbidity poses a significant clinical challenge and has been linked to greater health services use, including hospitalization; however, we have little knowledge about the influence of contextual factors on outcomes in this population. Objectives: To describe the extent to which the association between multimorbidity and hospitalization is modified by age, gender, primary care practice model, or continuity of care (COC) among adults with at least one chronic condition.

Methods

A retrospective cohort study with linked population-based administrative data.
Setting: Ontario, Canada. Cohort: All individuals 18 and older with at least one of 16 priority chronic conditions as of April 1, 2009 (baseline). Main Outcome Measures: Any hospitalization, 3 or more hospitalizations, non-medical discharge delay, and 30-day readmission within the 1 year following baseline.

Results

Of 5,958,514 individuals, 484,872 (8.1 %) experienced 646,347 hospitalizations. There was a monotonic increase in the likelihood of hospitalization and related outcomes with increasing multimorbidity which was modified by age, gender, and COC but not primary care practice model. The effect of increasing multimorbidity was greater in younger adults than older adults and in those with lower COC than with higher COC. The effect of increasing multimorbidity on hospitalization was greater in men than women but reversed for the other outcomes.

Conclusions

The effect of multimorbidity on hospitalization is influenced by age and gender, important considerations in the development of person-centred care models. Greater continuity of physician care lessened the effect of multimorbidity on hospitalization, further demonstrating the need for care continuity across providers for people with chronic conditions.
Appendix
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Metadata
Title
The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study
Authors
Andrea Gruneir
Susan E. Bronskill
Colleen J. Maxwell
Yu Qing Bai
Anna J. Kone
Kednapa Thavorn
Yelena Petrosyan
Andrew Calzavara
Walter P. Wodchis
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1415-5

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