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Cited by 175Chronic Disease Management StrategiesDementia and Cognitive Impairment ResearchPharmaceutical Practices and Patient Outcomes

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort

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Mondor, Luke, Maxwell, Colleen J., Hogan, David B., Bronskill, Susan E., Gruneir, Andrea, Lane, Natasha E., Wodchis, Walter P.·2017·PLOS Medicine
DOI 10.1371/journal.pmed.1002249PMC PMC5340355
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Abstract

BACKGROUND: For community-dwelling older persons with dementia, the presence of multimorbidity can create complex clinical challenges for both individuals and their physicians, and can contribute to poor outcomes. We quantified the associations between level of multimorbidity (chronic disease burden) and risk of hospitalization and risk of emergency department (ED) visit in a home care cohort with dementia and explored the role of continuity of physician care (COC) in modifying these relationships. METHODS AND FINDINGS: A retrospective cohort study using linked administrative and clinical data from Ontario, Canada, was conducted among 30,112 long-stay home care clients (mean age 83.0 ± 7.7 y) with dementia in 2012. Multivariable Fine-Gray regression models were used to determine associations between level of multimorbidity and 1-y risk of hospitalization and 1-y risk of ED visit, accounting for multiple competing risks (death and long-term care placement). Interaction terms were used to assess potential effect modification by COC. Multimorbidity was highly prevalent, with 35% (n = 10,568) of the cohort having five or more chronic conditions. In multivariable analyses, risk of hospitalization and risk of ED visit increased monotonically with level of multimorbidity: sub-hazards were 88% greater (sub-hazard ratio [sHR] = 1.88, 95% CI: 1.72-2.05, p < 0.001) and 63% greater (sHR = 1.63; 95% CI: 1.51-1.77, p < 0.001), respectively, among those with five or more conditions, relative to those with dementia alone or with dementia and one other condition. Low (versus high) COC was associated with an increased risk of both hospitalization and ED visit in age- and sex-adjusted analyses only (sHR = 1.11, 95% CI: 1.07-1.16, p < 0.001, for hospitalization; sHR = 1.07, 95% CI: 1.03-1.11, p = 0.001, for ED visit) but did not modify associations between multimorbidity and outcomes (Wald test for interaction, p = 0.566 for hospitalization and p = 0.637 for ED visit). The main limitations of this study include use of fixed (versus time-varying) covariates and focus on all-cause rather than cause-specific hospitalizations and ED visits, which could potentially inform interventions. CONCLUSIONS: Older adults with dementia and multimorbidity pose a particular challenge for health systems. Findings from this study highlight the need to reshape models of care for this complex population, and to further investigate health system and other factors that may modify patients' risk of health outcomes.

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Crossref · 10.1371/journal.pmed.1002249

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Fig 1 The association between level of multimorbidity and 1-y risk of acute hospitalization and emergency department visit as modified by continuity of care. Sub-hazard ratios account for the competing risks of death and long-term care admission. Estimates adjusted for age, sex, income, marital status, rurality, prior hospitalizations and ED visits, Minimum Data Set Health Status Index, and Changes in Health, End-stage disease and Symptoms and Signs scale. CC, chronic condition; COC, continuity of physician care.
Fig 1 The association between level of multimorbidity and 1-y risk of acute hospitalization and emergency department visit as modified by continuity of care. Sub-hazard ratios account for the competing risks of death and long-term care admission. Estimates adjusted for age, sex, income, marital status, rurality, prior hospitalizations and ED visits, Minimum Data Set Health Status Index, and Changes in Health, End-stage disease and Symptoms and Signs scale. CC, chronic condition; COC, continuity of physician care.CC BY · PubMed Central

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Metadata

Authors
Mondor, L., Maxwell, C. J., Hogan, D. B., Bronskill, S. E., Gruneir, A., Lane, N. E., & Wodchis, W. P.
Affiliations
  • Institute for Clinical Evaluative Sciences (CA)
  • University of Waterloo (CA)
  • University of Calgary (CA)
  • University of Toronto (CA)
  • University of Alberta (CA)
Corresponding author
Maxwell, Colleen J.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2017-03-07
Volume
14
Issue
3
Pages
e1002249
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1002249
PMC
PMC5340355
OpenAlex
W2594356587
Cited by
173
References
45
Citations by year
2026: 9 · 2025: 15 · 2024: 13 · 2023: 22 · 2022: 22 · 2021: 29 · 2020: 27 · 2019: 17 · 2018: 14 · 2017: 5
FWCI
13.49
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
Ontario Ministry of Health and Long-Term Care (06034)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
multimorbidity, dementia, home care, hospitalization, emergency department visits, health care utilization, chronic disease burden, community-dwelling older adults, competing risks, long-term care
MeSH terms
Aged, Aged, 80 and over, Dementia, Emergency Service, Hospital, Female, Home Care Services, Hospitalization, Humans, Male, Middle Aged, Ontario, Patient Acceptance of Health Care, Retrospective Studies, Cohort Studies, Comorbidity, Risk Assessment

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