ADMISSION

Research Collaborative

Transforming understanding of multiple long-term conditions (MLTC) in people admitted to hospital

Addressing critical gaps in our understanding of MLTC in hospitals

Delivering the knowledge needed to transform NHS systems of care for people with MLTC admitted to hospital

Integrating expertise from different academic disciplines and clinical specialities alongside lived experience

Multiple long-term conditions (MLTC) are highly prevalent among people admitted to hospital.  However, hospital systems are currently largely designed for the treatment of single conditions and so are not equipped to provide effective and efficient care for people living with MLTC.

‍ When compared with people living with no or a single long-term condition, people living with MLTC experience higher symptom and treatment burden, reduced quality of life, more complex care needs and increased risk of emergency hospitalisation. On admission to hospital, people living with MLTC also experience greater risk of adverse outcomes including longer length of stay, inpatient mortality and readmission after discharge. 

‍ Radical transformation of NHS systems of care for people with MLTC admitted to hospital is required to ensure our NHS is ‘fit for the future’.  This must be informed by robust evidence.  However, most research on MLTC to date has been conducted in primary care or the general population with comparatively little work undertaken in the hospital setting; an important evidence gap which the ADMISSION Research Collaborative has focused on addressing.

‍ The ADMISSION Research Collaborative, led by the AGE Research Group at Newcastle University and involving co-investigators from 5 UK centres, was funded by the UK Research and Innovation and the National Institute for Health and Care Research Strategic Priority Fund ‘Tackling Multimorbidity at Scale’ (2021 – 2025).

The main aim of ADMISSION was to deliver the knowledge needed to transform NHS systems of care for people with MLTC admitted to hospital. 

To achieve this, we have examined patterns of MLTC among people admitted to hospital and investigated risk factors, underlying mechanisms, lived experience and pathways of care.  This work has been undertaken using a wide range of data including routinely collected electronic health records from large UK teaching hospitals, population-based cohort data from UK Biobank, routinely collected blood samples from the Scottish Health Research Register and Biobank (SHARE) and qualitative data generated by interviewing people with MLTC admitted to hospital and healthcare professionals (Figure 1).

ADMISSION involved an interdisciplinary team with expertise in medicine, epidemiology, health informatics, computing, statistics, social science, genetics and care pathway mapping. Patient and Public Involvement was embedded throughout the programme from design to dissemination with regular input provided by two public co-investigators and a diverse and highly engaged patient advisory group.

Source: Witham et al. 2025

Alongside cross cutting work packages focusing on Patient and Public Involvement and Research Capacity Development, ADMISSION comprised five scientific work packages (Figure 2) with the following objectives:

  1. To build an aligned, curated, interoperable data platform containing routinely collected data from hospitalised patients across the acute care pathway

  2. To use a range of analytic approaches to describe the risk factors and outcomes of multiple long-term conditions in people admitted to hospital in the UK

  3. To investigate key drivers of inequality in MLTC within hospital settings and explore their impacts on health care pathways and outcomes

  4. To map conditions in the context of patient pathways to understand hospital-based health service use, antecedent events and consequences after admission

  5. To identify biological mechanisms underpinning groups of long-term conditions commonly seen in people admitted to hospital

By taking an integrative, interdisciplinary approach, and working in partnership with patients and the public, ADMISSION has developed a comprehensive picture of MLTC in the hospital setting.  We have:

Study Fact File

Principal Investigator: Professor Avan Sayer

Work Package Leads: Professor Rachel Cooper, Professor Heather Cordell & Professor Miles Witham, Newcastle University

Collaborating Institutions: Newcastle University, Newcastle upon Tyne Hospitals NHS Foundation Trust, University of Birmingham (PIONEER – the Health Data Research UK Acute Care Hub), Manchester Metropolitan University, University of Dundee and University College London

Funders: UK Research and Innovation (UKRI) & National Institute for Health and Care Research (NIHR)

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