Short summary

Multimorbidity (MM) is the occurrence of several diseases simultaneously in one person. MM is very expensive for the health care system and is associated with a perhaps unnecessary use of health care resources as the treatment of patients with multimorbidity takes place in a fragmented health care system. In order to optimize health care pathways for these patients there is a need for more knowledge about the epidemiology and health care utilization paths of patients with MM treated in hospital outpatient clinics. 

Rationale

About one fourth of the Danish population has two or more chronic diseases simultaneously. This group of people with multimorbidity (MM) is expanding as people live longer and medical treatment improves.

Research is however very single disease centered and there is relative little knowledge about the optimal treatment of patients with MM. Studies in this field have shown that patients suffer a greater disease and treatment burden and have worse outcomes than patients with only one chronic disease. Furthermore these patients are resource heavy and expensive for the health care system. Some studies show that total health care costs nearly increase at an exponential rate with each additional chronic condition.

In this research project we focus on patients with MM in hospital outpatient care. The overall aim is to optimize health care pathways for these patients. This project contributes by mapping the clinical epidemiology with regard to prevalence and patients health care utilization and furthermore identifying patient-groups to focus on.

Studies in the project include:

• Time trends in patients managed simultaneously in multiple hospital outpatient specialty clinics for chronic diseases: A register-based cross-sectional study (article published)
• Development of hospital outpatient visits among patients managed in multiple hospital outpatient specialty clinics for chronic diseases over a ten-year period.
• Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study (article published)
• Psychiatric and somatic co-morbidity in patients treated in secondary care sector in Denmark, A nation-wide, register-based study
• Prevalence of micro- and macrovascular complications in diabetes mellitus type 2 treated in secondary care

Description of the cohort

The project population consists of patients in hospital outpatient care. Patients are included in 2004, 2009 and 2014. 

Data and biological material

The National Patient Registry is used to identify patients and includes information on health care utilization from hospitals. Information from The National Health Insurance Service Register will provide information on health care utilization in general practice. Information on patient characteristics such as income level and education level will be added from Statistics Denmark. The Danish Civil Registration System will provide data on civil status, residents area and death.

This project does not collect biological material.

Collaborating researchers and departments

Medical department, Hospital Sønderjylland

Publications associated with the project

Time trends in patients managed simultaneously in multiple hospital outpatient specialty clinics for chronic diseases: A register-based cross-sectional study. Wolff DL, Von Plessen C, Waldorff FB, Sørensen TL, Bogh SB, Rubin KH, Mogensen CB. J Comorb. 2019 Feb 27;9:2235042X19831907. doi: 10.1177/2235042X19831907

Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study