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Defining multimorbidity in emergency department attendees and its impact on care processes, pathways and outcomes

Safe People

Organisation name

University of Edinburgh

Applicant name(s)

Prof Nazir Lone

Safe Projects

Project ID

DL_2023_036

Lay summary

People with two or more long-term conditions at the same time (multimorbidity) can have complex care needs. The number of people in our community with multimorbidity is increasing. People with multimorbidity may be less likely to benefit from treatments, because they may be more likely to experience side-effects of treatment than people without multimorbidity. This can be even more challenging in emergency situations, such as in hospital emergency departments. Very few researchers have looked at the care of people with multimorbidity in emergency departments, despite how common it now is in our communities. This research study will look into this issue. We will firstly find out how common multimorbidity is in people attending emergency departments in Lothian. We will then look at different ways of measuring multimorbidity, as well as frailty, to see whether this affects how common it is. We will then look into how these measures affect how likely it is that someone dies within 30 days of attending the emergency department, along with other outcomes. We will then use statistical methods to try and find groups of people who are more likely to experience poor outcomes. We hope our study will provide important information to help researchers, clinicians and the wider public to better understand what happens to people with multimorbidity when they need emergency care, with a longer-term aim of improving care for them.

Public benefit statement

Multimorbidity is defined as the presence of two more chronic conditions in a person at the same time. Around 50% of those aged 65-69 live with multimorbidity. However, multimorbidity is also common in younger people, especially in those living in socially deprived areas. Multimorbidity is predicted to become increasingly common and is now a priority area for research in the UK and also for NHS Lothian. People with multimorbidity are known to experience poorer health outcomes. In particular, those experiencing acute illness present specific challenges, including high unscheduled secondary care demand where time-critical decisions are required in the context of pressures on patient flow. Once admitted to hospital, people with multimorbidity have a longer length of stay and are at higher risk of adverse events, such as medication errors and therefore will benefit from an approach to care that takes account of multimorbidity. Very little research has been conducted on multimorbidity in emergency care contexts. This work will build on our earlier funded work. Benefits: The project will evaluate different ways of measuring multimorbidity in people attending emergency departments, compare this with a measure of frailty, and determine how this impacts on outcomes. This will improve future research undertaken in the area, ultimately improving person-centred care in patients with multimorbidity.

Request category type

Public Health Research

Latest approval date

08/11/2023

Safe Data

Dataset(s) name

Researcher-sourced data

Data sensitivity level

De-Personalised

Safe Setting

Access type

TRE