Outcomes of Patients with Mutiple Chronic Conditions among Specialists and Different Level of Hospitals

Background: An ageing population and advances in life-extending medical technologies has lead to an increasing number of individuals that suffer from multiple chronic conditions. These patients require higher than average medical services and polypharmacy. The complexity of these cases often results in fragmented medical care and difficulties in the co-ordination of health care providers. Furthermore, little research has been conducted regarding different specialists and hospital levels (Academic Medical Centers, Metropolitan Hospitals, Local Community Hospitals, Physician Clinics) for multiple chronic conditions. Purpose: The purpose of this study was to further understanding of the effect that different specialists and different levels of hospitals have on patients with multiple chronic diseases in Taiwan. The relationships among different care models and patient outcomes were also analyzed. Methods: This retrospective observational study is based on data from the Longitudinal Cohort of Diabetes Patients (LHDB) that was compiled by the National Health Research Institute (NHRI) for the years from 2005 to 2010. The representative samples were followed between 2004 and 2013. The patients in this study fell into three categories: diabetic patients with hypertension, diabetic patients with coronary artery disease, and diabetic patients with hypertension and coronary artery disease. After controlling for patient characteristics (sex, age, comorbidity, urbanization) we used multilevel modelling to elucidate the relationship between care models (specialist, hospital level) and diabetes indicators, hospitalization, medical emergencies, and medication possession ratios. Results: After controlling for patient characteristics, we found that patients suffering from diabetes had better outcomes when they were cared for by the Department of Endocrinology. Furthermore, patients with hypertension and coronary artery disease had better outcomes when cared for by the department of Cardiology and Endocrinology. When it came to the medication possession ratio (MPR), diabetic patients cared for by the Department of Endocrinology, and hypertension and coronary artery disease patients who were cared for by the Department of Cardiology had better outcomes. When it came to medical services, diabetic patients cared for by the Department of Family Medicine and Cardiology, and hypertension and coronary artery disease patients cared by the Department of Endocrinology needed fewer emergency services. Diabetic patients cared for by the Department of Family Medicine and Cardiology, and coronary artery disease patients cared for by the Department of Cardiology had shorter hospital stays. Diabetic patients with hypertension who were cared for by the Department of Family Medicine, the Department of Cardiology, and the Department of Internal Medicine had shorter hospital stays than those who were cared for by the Department of Endocrinology. Conclusion: The Department of Endocrinology showed better performance on most of the indicators. In regards to medication possession ratio (MPR), the Department of Endocrinology and Cardiology showed better performance. Departments of Family medicine, Endocrinology and Cardiology were utilized less for healthcare services. It is necessary to develop policies and continue physician education so physicians can change their care models; in the past they generally focused on a single disease but now they must develop a deeper understanding of the challenges that face patients with multiple chronic diseases. Future studies might further analyze care outcomes and explore the factors that influence the outcomes emerging from the care of different specialist physicians.