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

Lead Research Organisation: Newcastle University
Department Name: Translational and Clinical Res Institute

Abstract

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.

Technical Summary

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.

Publications

10 25 50
 
Description MULTIPLE
Amount £50,000 (GBP)
Organisation National Institute for Health Research 
Department NIHR Newcastle Biomedical Research Centre
Sector Academic/University
Country United Kingdom
Start 05/2021 
End 05/2022
 
Description Multimorbidity PhD programme for Health Professionals
Amount £8,568,661 (GBP)
Funding ID 223499/Z/21/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2022 
End 10/2029
 
Description OPTIMising therapies, disease trajectories, and AI assisted clinical management for patients Living with complex multimorbidity
Amount £2,495,158 (GBP)
Funding ID NIHR202632 
Organisation University of Birmingham 
Sector Academic/University
Country United Kingdom
Start 07/2021 
End 08/2024
 
Description The iDiabetes Platform: Enhanced Phenotyping of patients with diabetes for Precision Diagnosis, Prognosis and Treatment
Amount £2,800,000 (GBP)
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 05/2022 
End 05/2026
 
Description Therapies for long COVID in non-hospitalised individuals: from symptoms, patient-reported outcomes and immunology to targeted therapies (The TLC Study)
Amount £225,715,700 (GBP)
Organisation University of Birmingham 
Sector Academic/University
Country United Kingdom
Start 03/2021 
End 02/2023
 
Description Using artificial intelligence (AI) to characterize the dynamic inter- relationships between MUltiple Long-term condiTIons and PoLYpharmacy and across diverse UK populations and inform health care pathways (AI-MULTIPLY)
Amount £2,900,000 (GBP)
Funding ID NIHR203982 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2022 
End 09/2024
 
Title Umbrella governance structure 
Description This is a key development within Newcastle Hospitals to enable routine hospital data to be used for clinical research in a streamlined way. It consists of an overarching ethics and Confidentiality Advisory Group approval for multiple projects, overseen by a local Data Access Committee (DAC). Completing this work and starting the work of the DAC has been catalysed by, and is underpinned by, resource from ADMISSION. 
Type Of Material Data handling & control 
Year Produced 2021 
Provided To Others? No  
Impact Approval of first two research studies using routine hospital data. 
 
Description Membership of a new cross-collaborative Statistical Genetics Group to facilitate innovative collaborations in MLTC genetic epidemiology research 
Organisation University of Leicester
Country United Kingdom 
Sector Academic/University 
PI Contribution Membership of a new cross-collaborative Statistical Genetics Group to facilitate innovative collaborations in MLTC genetic epidemiology research.
Collaborator Contribution Membership of a new cross-collaborative Statistical Genetics Group to facilitate innovative collaborations in MLTC genetic epidemiology research.
Impact No impact yet.
Start Year 2022
 
Description ADMISSION Patient Advisory Group 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact TBC
Year(s) Of Engagement Activity 2021,2022
 
Description External Advisory Group formed 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact An External Advisory Group has been set up comprising of seven experts in relevant fields.

Prior to the first meeting, members were provided with a comprehensive briefing report. The first annual meeting involved the ADMISSION team presenting in detail the rationale for and explanation of the research, the achievements and challenges to date and the opportunity to pose questions to the expert panel. Feedback from the External Advisory Group was later collated to be taken forward as appropriate.
Year(s) Of Engagement Activity 2022
 
Description Host of the Inaugural UK MLTC Symposium 2022: Future directions for MLTC Research 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Arranged and hosted the Inaugural UK MLTC Symposium 2022: Future directions for MLTC Research. Keynote speaker Professor Lucy Chappell.

A free virtual event, which provided the opportunity to hear from leading UK researchers working in this rapidly evolving field and to find out how to become involved. The afternoon included a session dedicated to building networks with an opportunity to hear from early career researchers.

The event was designed for researchers and healthcare professionals but also welcomed delegates from all disciplines, including those who do not currently work in the area of MLTC.
Year(s) Of Engagement Activity 2022
URL https://research.ncl.ac.uk/admissioncollab/events/
 
Description Presentation at Newcastle University Faculty of Medical Sciences Long-Term Conditions and Multimorbidity Theme Event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Talk focussed on an overview of the ADMISSION programme - primary aim was to network and form links with other Newcastle University researchers with an interest in multiple long-term conditions. New collaborations across physical and mental health, and around multimorbidity in lung disease are starting to arise from this presentation.
Year(s) Of Engagement Activity 2021
 
Description Presentation at Strategic Priorities Fund (SPF) 'Tackling Multimorbidity at Scale' Wave 1 launch event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The SPF Wave 1 Launch Event featured the two initially funded SPF programmes, along with participation from other SPF-funded pilot programmes; the planned work of ADMISSION was presented and discussed. Event catalysed links between different programmes for future collaboration..
Year(s) Of Engagement Activity 2021
 
Description Presentation at Strategic Priorities Fund (SPF) Multimorbidity Wave 2 Launch and Networking Event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The SPF Wave 2 Launch Event celebrated the completion of commissioning for the SPF programme and the high-quality projects which have been funded.
There were four breakout room sessions which provided opportunities for attendees to discuss central questions relevant to multiple long-term conditions/ multimorbidity
research.
Year(s) Of Engagement Activity 2021
 
Description Presentation to Newcastle Biomedical Research Centre Informatics Group 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Presentation of ADMISSION programme to BRC Informatics group, with a particular focus on governance, links with BRC projects, and to stimulate new projects related to ADMISSION. One new project already submitted from BRC musculoskeletal theme that is relevant to the work of ADMISSION.
Year(s) Of Engagement Activity 2021
 
Description Regular seminar series 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Monthly seminar series include "spotlight" sessions involving a presentation and discussion from experts within a relevant research field. There is the opportunity to ask questions and make suggestions after the presentations. As well as being attended by collaborators, two public co-applicants also attend these sessions giving us the benefit of the opinions and suggestions of members of the public.

At the start of the project a number of "show and tell" sessions were arranged and presentations provided by PIONEER, Newcastle upon Tyne Hospitals NHS Foundation Trust and UCL outlining the data they could provide for the project and how this would be achieved. This led to discussions around data provision and governance structures and provided the basis for developing plans on accessing and curating the data required for the project.
Year(s) Of Engagement Activity 2021,2022
 
Description Website and Twitter account launched 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A project specific website has been created providing information on the rationale for the project, the research objectives and details of the collaborators involved. The design and content of the website were shared with our Patient Advisory Group who provided feedback on the layout, use of images and questions around accessibility, This feedback was incorporated into the final version of the website. Google Analytics show that we have had 144 users on the website with 621 page views to date.

A project specific Twitter account has also been launched with 184 Twitter users currently following us.
Year(s) Of Engagement Activity 2021,2022
URL https://research.ncl.ac.uk/admissioncollab/