Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA.
J Gen Intern Med. 2023 May;38(6):1449-1458. doi: 10.1007/s11606-022-07897-4. Epub 2022 Nov 16.
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.
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.
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.
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).
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.
“多病共存”一词用于识别高风险、复杂的患者，通常定义为≥2 种合并症。然而，这几乎将所有老年人都定义为多病共存，这使得该定义对医生、医院和决策者的用处不大。
为因急性心肌梗死（AMI）、心力衰竭（HF）和肺炎入院的患者制定新的特定于医疗状况的多病共存定义。我们为 AMI 和肺炎患者制定了三种特定于医疗状况的多病共存定义，将与 AMI 和肺炎患者 30 天全因死亡率增加一倍，或 HF 患者增加 1.5 倍相关的单一、双重或三重合并症组合（称为合格合并症集，QCS）定义为多病共存；与这些病症的典型患者相比。
基于队列的匹配研究
2016 年至 2019 年期间，100%的 Medicare 按服务收费患者因 AMI、HF 和肺炎住院。
30 天全因死亡率
我们将多病共存定义为存在≥1 个 QCS。与传统定义（≥2 种合并症）相比，新定义将更少的患者标记为多病共存，且死亡率风险更高。使用新定义与传统定义将患者标记为多病共存的比例为：AMI 为 47%比 87%（p 值<0.0001），HF 为 53%比 98%（p 值<0.0001），肺炎为 57%比 91%（p 值<0.0001）。与≥2 种合并症相比，患有≥1 个 QCS 的患者 30 天死亡率更高：AMI 为 15.0%比 9.5%（p<0.0001），HF 为 9.9%比 7.0%（p <0.0001），肺炎为 18.4%比 13.2%（p <0.0001）。
存在≥2 种合并症几乎将所有患者都定义为多病共存。相比之下，我们新的基于 QCS 的定义选择了与 AMI、HF 和肺炎入院的老年患者风险显著增加相关的更具体的合并症组合。因此，我们新的定义提供了一种更好的方法来识别多病共存患者，使医生、医院和决策者能够更有效地利用这些信息，为这些脆弱患者考虑有针对性的干预措施。
