Better multimorbidity-specific care was linked to fewer elective admissions a year later

Design

Retrospective cohort with concurrent and 12-month lagged analyses

Population

468,172 patients with multimorbidity in England

Primary outcome

Planned and unplanned secondary care use by quality indicator attainment

Effect

Multimorbidity-specific indicators associated with lower odds of elective admission at 12 months

This retrospective cohort used the Discover research platform in England to follow 468,172 patients with multimorbidity from April 2022 to March 2024. It combined practice quality indicators into scores and related them to hospital use, both at the same time and a year later.

Overall, patients whose care met more quality indicators also used more outpatient and emergency care at the same time — probably because sicker patients get more attention. The lagged analysis was more telling: higher attainment of multimorbidity-specific indicators was associated with lower odds of elective admission in the following 12 months. In patients with three or more conditions, it was also linked to fewer outpatient visits, while generic indicators were linked to fewer missed appointments.

This is observational and the effect sizes are not given in the abstract, so it cannot show that better primary care causes less hospital use. It does suggest that the multimorbidity-specific work — structured reviews, medication rationalisation, care planning — is where a practice's effort may pay off.

• Offer structured, combined reviews to patients with three or more long-term conditions rather than separate disease clinics.
• Include a medication review and a shared care plan in every multimorbidity review.
• Use frailty status to prioritise which multimorbid patients get the most intensive reviews.
• Track missed hospital appointments — generic good care was linked to fewer of them.

Why it matters

It points primary care effort at the patients where it may reduce downstream hospital work.

Don't overread it

This was observational; better-performing practices may differ in ways that also reduce hospital use.

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