Healthcare trajectories of individuals with multimorbidity: insights for improving integrated care

Abstract Background The number of people with multimorbidity is rising, often requiring care from multiple healthcare providers. Although an interdisciplinary care approach is recommended, unclear coordination responsibility contributes to fragmented care. This fragmentation can worsen patient outcomes, such as inappropriate medication use and increased hospital admissions, leading to high healthcare costs and thereby harming the sustainability of the healthcare system. Better insight into the care trajectories of individuals with multimorbidity is needed to inform integrated care recommendations and inform healthcare providers’ roles. Methods This retrospective observational study (2013-2022) used Dutch hospital claims data (Vektis) linked with electronic health record data from general practices (Nivel-PCD) for ∼180,000 individuals. Multimorbidity was defined as ≥ 2 chronic diseases. Prevalence proportions were calculated. Healthcare utilization patterns were analyzed over two years following the onset of multimorbidity. A fractional response regression examined the impact of age, sex, number of comorbidities, and death during follow-up on care fragmentation, measured by the Continuity of Care Index (COCI). Results Preliminary results show that the prevalence of multimorbidity increased from 15.2% to 29.5% (2013-2022). Within two years of multimorbidity onset, lower continuity of care (COCI) was observed among patients with a higher number of chronic conditions, older age, male sex, and those who died during follow-up, all statistically significant (p < 0.05). Conclusions This study highlights various patient characteristics associated with fragmented care, such as older age and a higher number of chronic conditions. These insights are important for improving integrated care for individuals with multimorbidity, especially in light of the growing prevalence of multimorbidity shown in this study and the need to ensure the sustainability of the healthcare system. Key messages • These findings can offer guidance in structuring the integrated care approach, including identifying which patient groups to target and which healthcare providers should be involved. • The findings of this study may also be useful for other countries to enhance care for individuals with multimorbidity and promote sustainable healthcare systems.