title: Effect of a Multidisciplinary Outpatient Model of Care on Health Outcomes in Older Patients with Multimorbidity: A Retrospective Case Control Study.
abstract: OBJECTIVE
  To evaluate a holistic multidisciplinary outpatient model of care on hospital readmission, length of stay and mortality in older patients with multimorbidity following discharge from hospital.
  
  
  METHODS
  A pilot case-control study between March 2006 and June 2009 of patients referred on discharge to a multidisciplinary, integrated outpatient model of care that includes outpatient follow-up, timely GP communication and dial-in service compared with usual care following discharge, within a metropolitan, tertiary referral, public teaching hospital. Controls were matched in a 4:1 ratio with cases for age, gender, index admission diagnosis and length of stay.
  
  
  METHODS
  Non-elective readmission rates, total readmission length of stay and overall survival.
  
  
  RESULTS
  A total of 252 cases and 1008 control patients were included in the study. Despite the patients referred to the multidisciplinary model of care had slightly more comorbid conditions, significantly higher total length of hospital stay in the previous 12 months and increased prevalence of diabetes and heart failure by comparison to those who received usual care, they had significantly improved survival (adjusted hazard ratio 0.70 95% CI 0.51-0.96, p = 0.029) and no excess in the number of hospitalisations observed.
  
  
  CONCLUSIONS
  Following discharge from hospital, holistic multidisciplinary outpatient management is associated with improved survival in older patients with multimorbidity. The findings of this study warrant further examination in randomised and cost-effectiveness trials.
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000.|Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace Adelaide, South Australia, 5000.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: Monash Cardiovascular Research Centre, Monash Health, Victoria, South Australia 3000.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Dundon
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000.
authors.forename: John
authors.initials: J
authors.lastname: Maddison
authors.affiliation: Clinical Education, School of Medicine, University of Adelaide, Adelaide, South Australia 5000.
authors.forename: Josephine
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000.
authors.forename: Melinda
authors.initials: M
authors.lastname: Stanners
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000.|School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, 5001.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Caughey
authors.affiliation: Department of Nursing Acute Care & Cardiovascular Research, Flinders University of South Australia, Adelaide, South Australia, 5001.
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome