Defining Multimorbidity in Older Patients Hospitalized with Medical Conditions.

Jain S, Rosenbaum PR, Reiter JG, Ramadan OI, Hill AS, Hashemi S, Brown RT, Kelz RR, Fleisher LA, Silber JH. Defining Multimorbidity in Older Patients Hospitalized with Medical Conditions. Journal of general internal medicine. 2023 May 1; 38(6):1449-1458.

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Abstract:

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 < 0.0001), HF 53% versus 98% (p value < 0.0001), and pneumonia 57% versus 91% (p value < 0.0001). Thirty-day mortality was higher among patients with = 1 QCS compared to = 2 comorbidities: for AMI 15.0% versus 9.5% (p < 0.0001), HF 9.9% versus 7.0% (p < 0.0001), and pneumonia 18.4% versus 13.2% (p < 0.0001). CONCLUSION: The presence of = 2 comorbidities identified almost all patients as multimorbid. In contrast, our new QCS-based definitions selected more specific combinations of comorbidities associated with substantial excess risk in older patients admitted for AMI, HF, and pneumonia. Thus, our new definitions offer a better approach to identifying multimorbid patients, allowing physicians, hospitals, and policymakers to more effectively use such information to consider focused interventions for these vulnerable patients.