Table 2

Outcomes for each study phase

Phase 1 outcomesPatient-related, medication-related and environment-related factors which can increase the risk of hospitalisation, emergency department visits, hospital readmission (notably due to MRPs), institutionalisation or early death.
Profiles of polymedicated, home-dwelling OAMCC hospitalised or visiting the emergency department due to MRPs based on the previously identified patient-related, medication-related and environment-related factors.
Phase 2 outcomesFor OAMCC participants:
  • Patient-related, medication-related and environment-related factors for MRPs (defined by phase 1’s outcomes) extracted from the RAI-HC MDS and the patient’s electronic hospital records (number and types of medication, multiple chronic conditions, recent hospitalisations, cognitive status, hearing, vision, mood status, functional and physical status, continence, healthcare problems and nutritional state).

  • Medication practices and experiences of OAMCC following their recent hospitalisation, facilitators/barriers to medication management, informal and professional caregivers involved.


For informal caregivers:
  • Sociodemographic profiles.

  • Practices and experiences related to medication management.


For professional caregivers:
  • Sociodemographic and professional profiles.

  • Role and perspectives on OAMCC medication management.

  • Coordination activities related to returning home after hospitalisation.

Phase 3 outcomesThree first steps in the process of developing a Model of Care43:
  • ‘Project initiation’.

  • ‘Diagnostic’.

  • ‘Solution design’ considering the quadruple aim.


Proposals for the Medication Management Model’s ‘Implementation’ and ‘Sustainability’ steps43 to support medication management and to prevent adverse health outcomes related to MRPs.
  • MDS, Minimal Data Set; MRPs, medication-related problems; OAMCC, older adults living with multiple chronic conditions; RAI-HC, Resident Assessment Instrument-Home Care.