The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

doi:10.1016/j.jdiacomp.2014.10.003

Comparative Study

. 2015 Mar;29(2):288-94.

doi: 10.1016/j.jdiacomp.2014.10.003. Epub 2014 Oct 13.

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

Elizabeth M Magnan¹, Mari Palta², Heather M Johnson³, Christie M Bartels³, Jessica R Schumacher⁴, Maureen A Smith⁵

Affiliations

¹ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA. Electronic address: elizabeth.magnan@ucdmc.ucdavis.edu.
² Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
³ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁵ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

PMID: 25456821
PMCID: PMC4333015
DOI: 10.1016/j.jdiacomp.2014.10.003

Comparative Study

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

Elizabeth M Magnan et al. J Diabetes Complications. 2015 Mar.

. 2015 Mar;29(2):288-94.

doi: 10.1016/j.jdiacomp.2014.10.003. Epub 2014 Oct 13.

Authors

Elizabeth M Magnan¹, Mari Palta², Heather M Johnson³, Christie M Bartels³, Jessica R Schumacher⁴, Maureen A Smith⁵

Affiliations

¹ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA. Electronic address: elizabeth.magnan@ucdmc.ucdavis.edu.
² Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
³ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁵ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

PMID: 25456821
PMCID: PMC4333015
DOI: 10.1016/j.jdiacomp.2014.10.003

Abstract

Aims: Most patients with diabetes have comorbid chronic conditions that could support (concordant) or compete with (discordant) diabetes care. We sought to determine the impact of the number of concordant and discordant chronic conditions on diabetes care quality.

Methods: Logistic regression analysis of electronic health record data from 7 health systems on 24,430 patients with diabetes aged 18-75 years. Diabetes testing and control quality care goals were the outcome variables. The number of diabetes-concordant and the number of diabetes-discordant conditions were the main explanatory variables. Analysis was adjusted for health care utilization, health system and patient demographics.

Results: A higher number of concordant conditions were associated with higher odds of achieving testing and control goals for all outcomes except blood pressure control. There was no to minimal positive association between the number of discordant conditions and outcomes, except for cholesterol testing which was less likely with 4+ discordant conditions.

Conclusions: Having more concordant conditions makes diabetes care goal achievement more likely. The number of discordant conditions has a smaller, inconsistently significant impact on diabetes goal achievement. Interventions to improve diabetes care need to align with a patient's comorbidities, including the absence of comorbidities, especially concordant comorbidities.

Keywords: Comorbidity; Diabetes; Multimorbidity; Multiple chronic conditions; Outcomes; Quality.

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References

1. American Diabetes Association Standards of medical care in diabetes--2011. Diabetes Care. 2011;34(Suppl 1):S11–61. - PMC - PubMed
1. American Diabetes Association Standards of medical care in diabetes--2014. Diabetes Care. 2014;37(Suppl 1):S14–80. - PubMed
1. Aung E, Donald M, Coll J, Dower J, Doi SA. The impact of concordant and discordant comorbidities on patient-assessed quality of diabetes care. Health Expectations. 2013 M. W. G. - PMC - PubMed
1. Bartels CM, Saucier JM, Thorpe CT, Kind AJ, Pandhi N, Hansen KE, Smith MA. Monitoring diabetes in patients with and without rheumatoid arthritis: a Medicare study. Arthritis Research and Therapy. 2012;14:R166. - PMC - PubMed
1. Bayliss EA, Bonds DE, Boyd CM, Davis MM, Finke B, Fox MH, Glasgow RE, Goodman RA, Heurtin-Roberts S, Lachenmayr S, Lind C, Madigan EA, Meyers DS, Mintz S, Nilsen WJ, Okun S, Ruiz S, Salive ME, Stange KC. Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Annals of Family Medicine. 2014;12:260–9. - PMC - PubMed

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[1] American Diabetes Association Standards of medical care in diabetes--2011. Diabetes Care. 2011;34(Suppl 1):S11–61. - PMC - PubMed

[2] American Diabetes Association Standards of medical care in diabetes--2011. Diabetes Care. 2011;34(Suppl 1):S11–61. - PMC - PubMed

[3] American Diabetes Association Standards of medical care in diabetes--2014. Diabetes Care. 2014;37(Suppl 1):S14–80. - PubMed

[4] American Diabetes Association Standards of medical care in diabetes--2014. Diabetes Care. 2014;37(Suppl 1):S14–80. - PubMed

[5] Aung E, Donald M, Coll J, Dower J, Doi SA. The impact of concordant and discordant comorbidities on patient-assessed quality of diabetes care. Health Expectations. 2013 M. W. G. - PMC - PubMed

[6] Aung E, Donald M, Coll J, Dower J, Doi SA. The impact of concordant and discordant comorbidities on patient-assessed quality of diabetes care. Health Expectations. 2013 M. W. G. - PMC - PubMed

[7] Bartels CM, Saucier JM, Thorpe CT, Kind AJ, Pandhi N, Hansen KE, Smith MA. Monitoring diabetes in patients with and without rheumatoid arthritis: a Medicare study. Arthritis Research and Therapy. 2012;14:R166. - PMC - PubMed

[8] Bartels CM, Saucier JM, Thorpe CT, Kind AJ, Pandhi N, Hansen KE, Smith MA. Monitoring diabetes in patients with and without rheumatoid arthritis: a Medicare study. Arthritis Research and Therapy. 2012;14:R166. - PMC - PubMed

[9] Bayliss EA, Bonds DE, Boyd CM, Davis MM, Finke B, Fox MH, Glasgow RE, Goodman RA, Heurtin-Roberts S, Lachenmayr S, Lind C, Madigan EA, Meyers DS, Mintz S, Nilsen WJ, Okun S, Ruiz S, Salive ME, Stange KC. Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Annals of Family Medicine. 2014;12:260–9. - PMC - PubMed

[10] Bayliss EA, Bonds DE, Boyd CM, Davis MM, Finke B, Fox MH, Glasgow RE, Goodman RA, Heurtin-Roberts S, Lachenmayr S, Lind C, Madigan EA, Meyers DS, Mintz S, Nilsen WJ, Okun S, Ruiz S, Salive ME, Stange KC. Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Annals of Family Medicine. 2014;12:260–9. - PMC - PubMed

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The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

Affiliations

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

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