The Impact of Nurse Practitioner-Led Multidisciplinary Team Intervention on the Implementation of Guideline-Directed Medical Therapy and Clinical Outcomes in Adults With Multimorbidity

Multimorbidity

The goal of this clinical trial is to evaluate whether a nurse practitioner-led multidisciplinary team (NP-led MDT) intervention can improve the use of guideline-directed medical therapy (GDMT) and short-term clinical outcomes in hospitalized adults with multimorbidity in a multidisciplinary medicine ward. The main questions it aims to answer are: Does NP-led MDT intervention increase the proportion of patients achieving GDMT at hospital discharge? Does NP-led MDT intervention reduce 30-, 60-, and 90-day readmission, emergency department visits, and mortality? Researchers will compare the NP-led MDT intervention group with the usual care group to see if the intervention improves GDMT implementation and clinical outcomes. Participants will: Be randomly assigned to NP-led MDT care or usual care. Have their medications reviewed according to the latest guidelines (intervention group only). Be followed for 90 days after discharge to collect outcomes through medical record review and telephone follow-up.

This is a prospective, single-center, randomized controlled trial designed to evaluate whether a nurse practitioner-led multidisciplinary team (NP-led MDT) intervention can improve the implementation rate of guideline-directed medical therapy (GDMT) and short-term clinical outcomes in hospitalized adults with multimorbidity. Multimorbidity is defined as the coexistence of two or more chronic conditions, including heart failure, hypertension, diabetes mellitus, chronic kidney disease, ischemic heart disease, and chronic obstructive pulmonary disease. Suboptimal use of GDMT is common in this population, contributing to poor clinical outcomes. Eligible patients admitted from the emergency department to the multidisciplinary medicine ward of a tertiary medical center will be screened within 72 hours of admission. Participants will be randomly assigned in a 1:1 ratio to either the NP-led MDT intervention group or the usual care group. In the intervention group, the NP-led MDT-comprising a nurse practitioner, physicians, and clinical pharmacists-will review each patient's diagnoses, comorbidities, baseline medications, and relevant laboratory or imaging results. Based on the latest international guidelines, the team will formulate individualized GDMT recommendations, which will be communicated to the patient's primary inpatient care team. The NP will also provide patient and caregiver education on medication adherence, potential side effects, and follow-up requirements. All final prescribing decisions will be made by the primary physician. In the usual care group, patients will receive standard inpatient management from their primary care team without additional structured NP-led MDT intervention. The primary outcome is the GDMT implementation rate at hospital discharge, calculated as the number of GDMT drugs prescribed divided by the number indicated according to guidelines. Secondary outcomes include all-cause readmission, emergency department visits, and mortality at 30, 60, and 90 days post-discharge, as well as selected disease-specific clinical indicators when available (e.g., left ventricular ejection fraction, HbA1c, blood pressure, LDL-C, eGFR). Follow-up will be conducted via medical record review and telephone contact. This trial aims to provide real-world evidence on whether an NP-led MDT approach can bridge the gap between guideline recommendations and actual prescribing practices, thereby improving both medication use and patient outcomes in multimorbid inpatients.

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