Figure 1
The Multidisciplinary Outpatient Pathway.
Table 1
Baseline characteristics of intervention group and comparison group in the Multidisciplinary Outpatient Pathway (MOP) at Silkeborg Regional Hospital (SRH) from 15 August 2018 to 11 March 2020.
| INTERVENTION GROUP | COMPARISON GROUP | p-VALUE | |||||
|---|---|---|---|---|---|---|---|
| N | % | MEDIAN (IQI) | N | % | MEDIAN (IQI) | ||
| Total | 131 | 524 | |||||
| Age | 71 (61–76) | 70 (61–77) | 0.65 | ||||
| Female gender | 55 | 42.0 | 226 | 43.1 | 0.84 | ||
| Civil status | |||||||
| Living with partner | 43 | 32.8 | 208 | 39.7 | |||
| Living alone | 88 | 67.2 | 316 | 60.3 | 0.16 | ||
| Distance to hospital, km | 7.5 (2.8–17.9) | 8.2 (3.3–21.7) | 0.04 | ||||
| Number of chronic conditionsa | 6 (4–9) | 6 (4–8) | 0.003 | ||||
| Healthcare utilisation at one year prior to baselineb | |||||||
| Hospital visits, SRH | 10 (7–14) | 7 (4–12) | <0.001 | ||||
| Hospital visits to the five selected outpatient clinics | 5 (2–8) | 4 (2–7) | 0.11 | ||||
| Outpatient contacts, SRH | 10 (7–14) | 8 (5–13) | <0.001 | ||||
| Outpatient contacts to the five selected outpatient clinics | 5 (2–8) | 5 (2–8) | 0.40 | ||||
| Outpatient clinics, SRH | 3 (2–5) | 3 (2–4) | <0.001 | ||||
| Outpatient clinics, other locations | |||||||
| Cardiology | 65 | 49.6 | 277 | 52.9 | |||
| Pulmonology | 83 | 63.4 | 212 | 40.5 | |||
| Endocrinology | 75 | 57.3 | 185 | 35.3 | |||
| Rheumatology | 48 | 36.6 | 195 | 37.2 | |||
| Nephrology | 27 | 20.6 | 74 | 14.1 | <0.001 | ||
| Contact to general practice, CDR | 12 (6–25) | 13 (6–21) | 0.64 | ||||
| Hospital admissions, CDR | |||||||
| Number of stays | 1 (0–2) | 1 (0–2) | 0.28 | ||||
| Length of stays, days | 3 (1–5) | 2 (2–5) | 0.49 | ||||
| Treatment burden, MTQBc | |||||||
| No burden, score 0 | 14 | 22.2 | 64 | 29.1 | |||
| Low burden, score <10 | 25 | 39.7 | 60 | 27.3 | |||
| Medium burden, score 10–22 | 21 | 33.3 | 60 | 27.3 | |||
| High burden, score ≥22 | 3 | 4.8 | 36 | 16.4 | |||
| Overall | 63 | 48.1 | 5 (2.5–12.5) | 220 | 42.0 | 5 (0–15) | 0.58 |
| N | % | MEAN (95%CI) | N | % | MEAN (95%CI) | p-VALUE | |
| Chronic illness care, PACICc | |||||||
| Patient activation | 69 | 52.7 | 3.4 (3.1–3.7) | 233 | 44.7 | 3.4 (3.2–3.5) | |
| Delivery system design/decision support | 69 | 52.7 | 3.6 (3.3–3.8) | 233 | 44.7 | 3.6 (3.5–3.7) | |
| Goal setting | 69 | 52.7 | 2.7 (2.5–3.0) | 233 | 44.7 | 2.6 (2.4–2.7) | |
| Problem-solving/Contextual counselling | 68 | 51.9 | 3.1 (2.8–3.4) | 230 | 43.9 | 2.8 (2.7–3.0) | |
| Follow-up/coordination | 69 | 52.7 | 2.3 (2.0–2.5) | 227 | 43.3 | 2.1 (1.9–2.2) | |
| Overall | 69 | 52.7 | 2.9 (2.7–3.1) | 334 | 44.7 | 2.8 (2.7–2.9) | 0.24 |
| Well-being, SF-12c | |||||||
| Physical health | 64 | 48.9 | 32.2 (25.6–42.1) | 218 | 41.5 | 37.8 (27.4–47.2) | 0.87 |
| Mental health | 64 | 48.9 | 46.0 (36.8–56.5) | 218 | 41.5 | 46.7 (39.1–54.0) | 0.62 |
[i] CDR: Central Denmark Region, IQI: Interquartile interval, km = kilometres, N: numbers, SRH: Silkeborg Regional Hospital. aOut of 39 diagnoses from the Danish Multimorbidity Index. bGP daytime consultations including email consultations and telephone consultations. cIncluding persons responding ≥50%.
Table 2
Questionnaire responses from intervention patients assessed before and after entering the Multidisciplinary Outpatient Pathway.
| TOTAL RESPONSE | PAIRED BEFORE-AFTER RESPONSES | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BASELINE | AFTER INTERVENTION | BASELINE | AFTER INTERVENTION | p-VALUE | |||||||||
| N, % | MEAN SCORE | 95%CI | N, % | MEAN SCORE | 95%CI | N, % | MEAN SCORE | 95%CI | N, % | MEAN SCORE | 95%CI | ||
| Total | 131 (100) | 131 (100) | 131 (100) | 131 (100) | |||||||||
| Chronic illness care (PACIC) | |||||||||||||
| Patient activation | 69 (52.7) | 3.4 | (3.1–3.7) | 73 (55.7) | 3.4 | (3.2–3.7) | 55 (42.0) | 3.4 | (3.09–3.74) | 55 (42.0) | 3.4 | (3.16–3.73) | |
| Delivery system design/decision support | 69 (52.7) | 3.6 | (3.3–3.8) | 73 (55.7) | 3.6 | (3.4–3.8) | 55 (42.0) | 3.7 | (3.41–3.90) | 55 (42.0) | 3.6 | (3.38–3.86) | |
| Goal setting | 69 (52.7) | 2.7 | (2.5–3.0) | 72 (55.7) | 2.6 | (2.4–2.8) | 55 (42.0) | 2.9 | (2.60–3.15) | 55 (42.0) | 2.6 | (2.31–2.87) | |
| Problem-solving/contextual counselling | 68 (51.9) | 3.1 | (2.8–3.4) | 72 (55.0) | 3.0 | (2.7–3.3) | 55 (42.0) | 3.2 | (2.89–3.52) | 55 (42.0) | 3.1 | (2.76–3.40) | |
| Follow-up/coordination | 69 (52.7) | 2.3 | (2.0–2.5) | 72 (55.0) | 2.2 | (2.0–2.5) | 55 (42.0) | 2.4 | (2.08–2.69) | 55 (42.0) | 2.3 | (2.01–2.56) | |
| Overall | 69 (52.7) | 2.9 | (2.7–3.1) | 73 (55.7) | 2.9 | (2.7–3.1) | 55 (42.0) | 3.0 | (2.77–3.26) | 55 (42.0) | 2.9 | (2.66–3.14) | 0.15 |
| N, % | MEDIAN SCORE | IQI | N, % | MEDIAN SCORE | IQI | N, % | MEDIAN SCORE | IQI | N, % | MEDIAN SCORE | IQI | p-VALUE | |
| Treatment burden (MTQB) | |||||||||||||
| No burden, score 0 | 14 (22.2) | 22 (33.3) | 12 (25.5) | 16 (34.0) | |||||||||
| Low burden, score <10 | 25 (39.7) | 20 (30.3) | 18 (38.3) | 15 (31.9) | |||||||||
| Medium burden, score 10–22 | 21 (33.3) | 16 (24.2) | 16 (34.0) | 12 (25.5) | |||||||||
| High burden, score ≥22 | 3 (4.8) | 8 (12.1) | 1 (2.1) | 4 (8.5) | |||||||||
| Overall | 63 (48.1) | 5 | (2.5–12.5) | 66 (50.4) | 5 | (0–12.5) | 47 (36.0) | 5 | (0–12.5) | 47 (36.0) | 5 | (0–12.5) | 0.55 |
[i] The numbers include persons responding to ≥50% to items. An average score was applied for intervention patients who entered the intervention more than one time. N: numbers, PACIC: Patient Assessment of Chronic Illness Care, MTBQ: Multimorbidity Treatment Burden Questionnaire, 95% CI: 95% confidence interval, IQI: interquartile interval.
Table 3
Incidence rate ratios and incidence rate ratio ratios of healthcare utilisation (at one year after and one year before) for patients included in the Multidisciplinary Outpatient Pathway (MOP) intervention compared to patients not included from 15 August 2018 to 11 March 2020.
| CRUDE | ADJUSTEDd | |||||
|---|---|---|---|---|---|---|
| IRR | IRRR | 95%CI | IRRR | 95%CI | p-VALUE | |
| SILKEBORG REGIONAL HOSPITAL | ||||||
| Hospital outpatient visitsa | ||||||
| Comparison group | 0.90 | 0.79 | (0.66–0.94) | 0.81 | (0.69–0.94) | |
| Intervention group | 0.71 | 0.01 | ||||
| Outpatient contacts | ||||||
| Comparison group | 0.64 | 0.86 | (0.71–1.03) | 0.89 | (0.76–1.04) | |
| Intervention group | 0.55 | 0.13 | ||||
| Blood samplesb | ||||||
| Comparison group | 1.01 | 0.84 | (0.72–0.96) | 0.83 | (0.73–0.96) | |
| Intervention group | 0.85 | 0.01 | ||||
| Terminated outpatient trajectories | ||||||
| Comparison group | 1.39 | 0.90 | (0.79–1.02) | 0.91 | (0.80–1.03) | |
| Intervention group | 1.25 | 0.13 | ||||
| CENTRAL DENMARK REGION | ||||||
| Number of admissions | ||||||
| Comparison group | 0.97 | 0.97 | (0.91–1.04) | 1.02 | (0.97–1.08) | |
| Intervention group | 0.96 | 0.43 | ||||
| Days of admission | ||||||
| Comparison group | 0.31 | 0.91 | (0.46–1.79) | 1.43 | (0.69–2.96) | |
| Intervention group | 0.36 | 0.39 | ||||
| GP contactsc | ||||||
| Comparison group | 0.84 | 0.96 | (0.83–1.09) | 0.99 | (0.86–1.13) | |
| Intervention group | 0.80 | 0.83 | ||||
[i] Person time at risk was followed for one year from baseline until leaving the region, death, or end of follow-up. Time with admission was deducted person time at risk, except from the variable ‘Days of admission’. IQI: Interquartile interval, N: numbers, 95%CI: 95% confidence interval. aTimes going to Silkeborg Regional Hospital. bSame-day blood samples requested from outpatient clinics. cGP daytime consultations including email consultations and telephone consultations. dAdjusted for age, gender, number of chronic conditions and number of specialties, as categorical variables.
| ATC | Anatomical therapeutic chemical |
| CI | Confidence interval |
| GP | General practitioner |
| MOP | Multidisciplinary outpatient pathway |
| IRRs | Incidence rate ratios |
| IRRRs | Incidence rate ratio ratios |
| IQI | Interquartile interval |
| MTBQ | Multimorbidity Treatment Burden Questionnaire |
| PACIC | Patient Assessment of Chronic Illness Care (questionnaire) |
| PREMs | Patient-reported experience measures |
| SELFIE | Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE |