ADMISSION UK Multimorbidity Research Collaborative on Multiple Long-Term Conditions in Hospital: from burden and inequalities to underlying mechanisms

Why is multimorbidity important?
Multimorbidity, that is living with multiple long-term health conditions, is very common in people admitted to hospital. These patients tend to stay in hospital for longer, are more likely to die, and may take much longer to recover when they are discharged. However, the way we deliver care for people with multiple long-term conditions is not ideal; in a system that was designed for single conditions, care can be unsatisfactory and inefficient for the patient - and is expensive for the healthcare provider, such as the NHS. The need for improvement is recognised, but there is currently little research on multimorbidity in hospital patients to help us to know how services need to be changed. Our research is designed to address this gap in understanding and is focused on people with multiple long-term conditions who are admitted to hospital.

What is ADMISSION?
We have formed a new Research Collaborative (called ADMISSION) that includes data scientists, statisticians, laboratory researchers, social scientists and clinical teams from UK universities (Newcastle, Birmingham, Manchester Met, UCL, Dundee) to carry out research that will transform our understanding of multiple long-term conditions in hospital patients. By bringing together this expertise we will be able to use the power of 'big data' (from routine NHS and other datasets) to better understand the patterns and causes of multiple long-term conditions, and the effects of living with them. The Collaborative will use information collected by hospitals in the North East of England, Birmingham and Dundee, and from intensive care wards across the UK, to identify patients with long-term conditions. We will pay particular attention to patients who have a combination of physical health conditions (for example heart disease, lung disease, arthritis, falls and poor mobility) and mental health conditions (for example dementia and depression).

What will ADMISSION do?
Our planned research is divided into five linked work packages, with each helping the work of the others. Our first work package will build a library of information gathered from Newcastle Hospitals and will compare this with similar libraries of information from Birmingham hospitals and intensive care units across the UK. Our second work package will analyse this information to find patterns of health conditions as these tend to cluster together, so that we can look at the effects of background factors such as age, sex, and ethnicity on them (in our third work package). Our fourth work package will use information from ambulance services, accident and emergency, acute hospital admissions and general practice records to understand how we deliver health care to people with clusters of multiple long-term conditions, how they journey through the healthcare system and how we might be able to improve their experience of health and social care. Our final work package looks at the mechanisms that could explain what causes the clusters of long-term conditions; we will analyse genetic and other information from half a million people who signed up to the UK Biobank study to find out how genes vary between different clusters of conditions, and then test these ideas using blood samples collected from 3000 hospital patients in the SHARE Scotland registry.

What will the end result of ADMISSION be?
This work will lead to a step change in our understanding of how long-term conditions cluster together in hospital patients, why they cluster, and how these different clusters affect health and the delivery of health care. With this understanding we will be able to design new approaches to treat and prevent multiple long-term conditions, and to improve the health, function and quality of life of people who have them. It will also inform the redesign of health and social care systems so that they are better able to care for patients with multiple long-term conditions in the future.

ADMISSION is an interdisciplinary UK Research Collaborative that will transform our understanding of the burden, causes, treatment and prevention of multiple long-term conditions in hospitalised patients. Central to the success of ADMISSION will be the creation and alignment of data across platforms, harnessing the Newcastle Hospitals Global Digital Exemplar electronic health record, the HDRUK Hub Acute Care (PIONEER, Birmingham), and the NIHR Biomedical Research Centres Health Informatics Collaborative in Critical Care (UCL) for the first time.

The work is divided into five linked work packages that will: 1) use electronic health records to develop harmonised data platforms; 2) analyse these data to define clusters of medical conditions, using conventional and new cutting-edge techniques to describe the burden of multiple long-term conditions; 3) generate new knowledge of the impact of inequalities in these clusters according to differences in age, socioeconomic status and access to healthcare; 4) map these clusters of conditions against patient pathways to understand antecedent events, trajectories of care and future consequences; and 5) explore underpinning mechanisms through a combination of genetic epidemiology in large existing datasets and targeted phenotypic confirmation using existing biobanked samples linked to routinely collected data.

A key feature of the Collaborative is that the researchers come from a wide range of disciplines (including data science, statistics, social science, epidemiology, genetics, primary and secondary care). Allied to strong patient partnerships and geographical reach across its centres (Newcastle, Birmingham, UCL, Manchester, Dundee), ADMISSION will offer unrivalled opportunities both to share expertise and to include comparative analyses and cross-validation within and beyond the Collaborative. This new learning, whilst of particular relevance to the UK context, will inform hospital-based care globally.