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

J Diabetes Complications. 2015 Mar;29(2):288-94. doi: 10.1016/j.jdiacomp.2014.10.003. Epub 2014 Oct 13.

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy*
  • Comorbidity
  • Diabetes Complications / prevention & control*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Electronic Health Records
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hyperglycemia / prevention & control
  • Logistic Models
  • Male
  • Middle Aged
  • Midwestern United States / epidemiology
  • Patient Acceptance of Health Care
  • Primary Health Care*
  • Quality of Health Care*
  • Terminology as Topic
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human