Multimorbidity-associated emergency hospital admissions: a “screen and link” strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol

Author:

Spencer Stephen A.ORCID,Rutta AliceORCID,Hyuha GimboORCID,Banda Gift TreighcyORCID,Choko Augustine,Dark Paul,Hertz Julian T.,Mmbaga Blandina T.ORCID,Mfinanga Juma,Mijumbi Rhona,Muula Adamson,Nyirenda Mulinda,Rosu Laura,Rubach Matthew,Salimu Sangwani,Sakita Francis,Salima Charity,Sawe HendryORCID,Simiyu IbrahimORCID,Taegtmeyer MiriamORCID,Urasa Sarah,White Sarah,Yongolo Nateiya M.ORCID,Rylance Jamie,Morton BenORCID,Worrall EveORCID,Limbani FelixORCID,

Abstract

Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Funder

Wellcome Trust

National Institute for Health and Care Research

Research, Evidence and Development Initiative (READ-It), funded by UK aid from the UK government

NIHR Senior Investigator Award

Publisher

National Institute for Health and Care Research

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