The effect of nurse care management on multimorbid patients' hospital utilization: a comparative-controlled trial and an exploratory cohort study.

Multimorbidity, defined as the presence of two or more chronic conditions in one individual, poses substantial challenges to patients and healthcare systems, yet evidence regarding effective primary care interventions remains limited. We report on a two-year comparative controlled trial aimed to assess the effects of the nurse-led Comprehensive Care for Multimorbid Adults Program (CC-MAP), on patient outcomes. A total of 1,210 adults with multimorbidity were enrolled (610 in seven intervention clinics and 600 in six usual-care clinics). The primary outcome was the number of unplanned admissions. Secondary outcomes included the number of 30-day readmissions, self-reported physical and mental health, and functional status. Adjusted mean differences between groups were estimated using analysis-of-covariance. At one year, no significant between-group differences were observed. At two years, the intervention group had lower adjusted mean unplanned hospital admissions (- 0.468; 95% CI - 0.815 to -0.121) and lower 30-day readmissions (- 0.202; 95% CI - 0.370 to -0.034), relative to controls. Our findings support the potential sustainability and scalability of the CC-MAP primary care model for patients with multimorbidity. (ClinicalTrials.gov (Identifier: NCT01811173)).