The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study.
Multimorbidity poses a significant clinical challenge and has been linked to greater health services use, including hospitalization; however, we have little knowledge about the influence of contextual factors on outcomes in this population.



To describe the extent to which the association between multimorbidity and hospitalization is modified by age, gender, primary care practice model, or continuity of care (COC) among adults with at least one chronic condition.



A retrospective cohort study with linked population-based administrative data.



Ontario, Canada.



All individuals 18 and older with at least one of 16 priority chronic conditions as of April 1, 2009 (baseline).



Any hospitalization, 3 or more hospitalizations, non-medical discharge delay, and 30-day readmission within the 1 year following baseline.



Of 5,958,514 individuals, 484,872 (8.1 %) experienced 646,347 hospitalizations. There was a monotonic increase in the likelihood of hospitalization and related outcomes with increasing multimorbidity which was modified by age, gender, and COC but not primary care practice model. The effect of increasing multimorbidity was greater in younger adults than older adults and in those with lower COC than with higher COC. The effect of increasing multimorbidity on hospitalization was greater in men than women but reversed for the other outcomes.



The effect of multimorbidity on hospitalization is influenced by age and gender, important considerations in the development of person-centred care models. Greater continuity of physician care lessened the effect of multimorbidity on hospitalization, further demonstrating the need for care continuity across providers for people with chronic conditions.
Department of Family Medicine, University of Alberta, 6-40 University Terrace, Edmonton, Alberta, T6G 2T4, Canada. gruneir@ualberta.ca.|Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, Ontario, M4N 3M5, Canada. gruneir@ualberta.ca.
Andrea
A
Gruneir
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, Ontario, M4N 3M5, Canada.|Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
Susan E
SE
Bronskill
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, Ontario, M4N 3M5, Canada.|School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
Colleen J
CJ
Maxwell
Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
Yu Qing
YQ
Bai
Cancer Care Ontario, 620 University Ave, Toronto, Ontario, M5G 2L7, Canada.
Anna J
AJ
Kone
Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, K1H 8L6, Canada.
Kednapa
K
Thavorn
Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
Yelena
Y
Petrosyan
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, Ontario, M4N 3M5, Canada.
Andrew
A
Calzavara
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, Ontario, M4N 3M5, Canada.|School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
Walter P
WP
Wodchis
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000592:standards*; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009864:Ontario / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
Age; Chronic conditions; Continuity of care; Readmission; Sex and gender