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

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.

Inclusion criteria

• Age: 18 years or older
• Admitted to the multidisciplinary ward through the emergency department for inpatient care
• Diagnosed with at least one of the following six chronic conditions and concurrently having one or more additional chronic diseases:

• Congestive Heart Failure (CHF)
• Diabetes Mellitus (DM)
• Hypertension (HTN)
• Dyslipidemia (DLP)
• Atrial Fibrillation (AF)
• Chronic Kidney Disease (CKD)

Exclusion criteria

• End-of-life (EOL) patients: Refers to patients receiving palliative care or those assessed by the medical team as unlikely to survive to discharge during the current hospitalization.
• Patients expected to be transferred to other departments: For example, patients anticipated to be transferred to oncology, intensive care unit (ICU), surgery, or other departments where full MDT intervention cannot be implemented.
• Unwilling to participate.
• Patients under the care of the study team physician on the day of hospitalization.
• Patients known to be economically or educationally disadvantaged