Establishing chronic condition concordance and discordance with diabetes: a Delphi study

doi:10.1186/s12875-015-0253-6

. 2015 Mar 28:16:42.

doi: 10.1186/s12875-015-0253-6.

Establishing chronic condition concordance and discordance with diabetes: a Delphi study

Elizabeth M Magnan^{1

2}, Rebecca Gittelson³, Christie M Bartels^{4

5}, Heather M Johnson^{6

7}, Nancy Pandhi^{8

9}, Elizabeth A Jacobs^{10

11}, Maureen A Smith^{12

13

14

15}

Affiliations

¹ Department of Family and Community Medicine, University of California, Davis, UC Davis School of Medicine, 4860 Y street, suite 2320, Sacramento, CA, 95817, USA. elizabeth.magnan@ucdmc.ucdavis.edu.
² Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. elizabeth.magnan@ucdmc.ucdavis.edu.
³ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. rgittel@live.unc.edu.
⁴ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. cb4@medicine.wisc.edu.
⁵ Department of Medicine, University of Wisconsin, Madison, WI, USA. cb4@medicine.wisc.edu.
⁶ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. hm2@medicine.wisc.edu.
⁷ Department of Medicine, University of Wisconsin, Madison, WI, USA. hm2@medicine.wisc.edu.
⁸ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. nancy.pandhi@fammed.wisc.edu.
⁹ Department of Family Medicine, University of Wisconsin, Madison, WI, USA. nancy.pandhi@fammed.wisc.edu.
¹⁰ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. eajacobs@medicine.wisc.edu.
¹¹ Department of Medicine, University of Wisconsin, Madison, WI, USA. eajacobs@medicine.wisc.edu.
¹² Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. maureensmith@wisc.edu.
¹³ Department of Family Medicine, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.
¹⁴ Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.
¹⁵ Department of Surgery, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.

PMID: 25887080
PMCID: PMC4391600
DOI: 10.1186/s12875-015-0253-6

Establishing chronic condition concordance and discordance with diabetes: a Delphi study

Elizabeth M Magnan et al. BMC Fam Pract. 2015.

. 2015 Mar 28:16:42.

doi: 10.1186/s12875-015-0253-6.

Authors

Elizabeth M Magnan^{1

2}, Rebecca Gittelson³, Christie M Bartels^{4

5}, Heather M Johnson^{6

7}, Nancy Pandhi^{8

9}, Elizabeth A Jacobs^{10

11}, Maureen A Smith^{12

13

14

15}

Affiliations

¹ Department of Family and Community Medicine, University of California, Davis, UC Davis School of Medicine, 4860 Y street, suite 2320, Sacramento, CA, 95817, USA. elizabeth.magnan@ucdmc.ucdavis.edu.
² Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. elizabeth.magnan@ucdmc.ucdavis.edu.
³ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. rgittel@live.unc.edu.
⁴ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. cb4@medicine.wisc.edu.
⁵ Department of Medicine, University of Wisconsin, Madison, WI, USA. cb4@medicine.wisc.edu.
⁶ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. hm2@medicine.wisc.edu.
⁷ Department of Medicine, University of Wisconsin, Madison, WI, USA. hm2@medicine.wisc.edu.
⁸ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. nancy.pandhi@fammed.wisc.edu.
⁹ Department of Family Medicine, University of Wisconsin, Madison, WI, USA. nancy.pandhi@fammed.wisc.edu.
¹⁰ Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. eajacobs@medicine.wisc.edu.
¹¹ Department of Medicine, University of Wisconsin, Madison, WI, USA. eajacobs@medicine.wisc.edu.
¹² Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. maureensmith@wisc.edu.
¹³ Department of Family Medicine, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.
¹⁴ Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.
¹⁵ Department of Surgery, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.

PMID: 25887080
PMCID: PMC4391600
DOI: 10.1186/s12875-015-0253-6

Abstract

Background: The vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of care; however, clinical practice guidelines, interventions, and public reporting metrics do not adequately address the interaction of these multiple conditions. To advance the understanding of diabetes clinical care in the context of multiple chronic conditions, we must understand how care overlaps, or doesn't, between diabetes and its co-occurring conditions. This study aimed to determine which chronic conditions are concordant (share care goals with diabetes) and discordant (do not share care goals) with diabetes care, according to primary care provider expert opinion.

Methods: Using the Delphi technique, we administered an iterative, two-round survey to 16 practicing primary care providers in an academic practice in the Midwestern USA. The expert panel determined which specific diabetes care goals were also care goals for other chronic conditions (concordant) and which were not (discordant). Our diabetes care goals were those commonly used in quality reporting, and the conditions were 62 ambulatory-relevant condition categories.

Results: Sixteen experts participated and all completed both rounds. Consensus was reached on the first round for 94% of the items. After the second round, 12 conditions were concordant with diabetes care and 50 were discordant. Of the concordant conditions, 6 overlapped in care for 4 of 5 diabetes care goals and 6 overlapped for 3 of 5 diabetes care goals. Thirty-one discordant conditions did not overlap with any of the diabetes care goals, and 19 overlapped with only 1 or 2 goals.

Conclusions: This study significantly adds to the number of conditions for which we have information on concordance and discordance for diabetes care. The results can be used for future studies to assess the impact of concordant and discordant conditions on diabetes care, and may prove useful in developing multimorbidity guidelines and interventions.

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Figures

**Figure 1**
**Establishing chronic conditions’ goal-specific and overall concordance and discordance with diabetes.**

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References

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1. Laiteerapong N, Huang ES, Chin MH. Prioritization of care in adults with diabetes and comorbidity. Ann N Y Acad Sci. 2011;1243:69–87. doi: 10.1111/j.1749-6632.2011.06316.x. - DOI - PMC - PubMed
1. Bae S, Rosenthal MB. Patients with multiple chronic conditions do not receive lower quality of preventive care. J Gen Intern Med. 2008;23(12):1933–9. doi: 10.1007/s11606-008-0784-9. - DOI - PMC - PubMed
1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed
1. Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, et al. Relationship between number of medical conditions and quality of care. N Engl J Med. 2007;356(24):2496–504. doi: 10.1056/NEJMsa066253. - DOI - PubMed

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[1] Schneider KM, O’Donnell BE, Dean D. Prevalence of multiple chronic conditions in the United States’ Medicare population. Health Qual Life Outcomes. 2009;7:82. doi: 10.1186/1477-7525-7-82. - DOI - PMC - PubMed

[2] Schneider KM, O’Donnell BE, Dean D. Prevalence of multiple chronic conditions in the United States’ Medicare population. Health Qual Life Outcomes. 2009;7:82. doi: 10.1186/1477-7525-7-82. - DOI - PMC - PubMed

[3] Laiteerapong N, Huang ES, Chin MH. Prioritization of care in adults with diabetes and comorbidity. Ann N Y Acad Sci. 2011;1243:69–87. doi: 10.1111/j.1749-6632.2011.06316.x. - DOI - PMC - PubMed

[4] Laiteerapong N, Huang ES, Chin MH. Prioritization of care in adults with diabetes and comorbidity. Ann N Y Acad Sci. 2011;1243:69–87. doi: 10.1111/j.1749-6632.2011.06316.x. - DOI - PMC - PubMed

[5] Bae S, Rosenthal MB. Patients with multiple chronic conditions do not receive lower quality of preventive care. J Gen Intern Med. 2008;23(12):1933–9. doi: 10.1007/s11606-008-0784-9. - DOI - PMC - PubMed

[6] Bae S, Rosenthal MB. Patients with multiple chronic conditions do not receive lower quality of preventive care. J Gen Intern Med. 2008;23(12):1933–9. doi: 10.1007/s11606-008-0784-9. - DOI - PMC - PubMed

[7] Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

[8] Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

[9] Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, et al. Relationship between number of medical conditions and quality of care. N Engl J Med. 2007;356(24):2496–504. doi: 10.1056/NEJMsa066253. - DOI - PubMed

[10] Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, et al. Relationship between number of medical conditions and quality of care. N Engl J Med. 2007;356(24):2496–504. doi: 10.1056/NEJMsa066253. - DOI - PubMed

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Establishing chronic condition concordance and discordance with diabetes: a Delphi study

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Establishing chronic condition concordance and discordance with diabetes: a Delphi study

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