The relationship of individual comorbid chronic conditions to diabetes care quality

doi:10.1136/bmjdrc-2015-000080

. 2015 Jul 23;3(1):e000080.

doi: 10.1136/bmjdrc-2015-000080. eCollection 2015.

The relationship of individual comorbid chronic conditions to diabetes care quality

Elizabeth M Magnan¹, Mari Palta², Jane E Mahoney³, Nancy Pandhi⁴, Daniel M Bolt⁵, Jennifer Fink⁶, Robert T Greenlee⁷, Maureen A Smith⁸

Affiliations

¹ Department of Family and Community Medicine , University of California, Davis , Sacramento, California , USA ; Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
² Department of Biostatistics and Medical Informatics , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
³ Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
⁴ Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Family Medicine , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
⁵ Department of Educational Psychology , University of Wisconsin-Madison , Madison, Wisconsin , USA.
⁶ Department of Health Informatics and Administration , College of Health Sciences , University Wisconsin Milwaukee , Milwaukee, Wisconsin , USA ; Center for Urban Population Health , Milwaukee, Wisconsin , USA ; Aurora Research Institute, Aurora Health Care , Milwaukee, Wisconsin , USA.
⁷ Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation , Marshfield, WI , USA.
⁸ Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Family Medicine , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Surgery , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.

PMID: 26217492
PMCID: PMC4513351
DOI: 10.1136/bmjdrc-2015-000080

The relationship of individual comorbid chronic conditions to diabetes care quality

Elizabeth M Magnan et al. BMJ Open Diabetes Res Care. 2015.

. 2015 Jul 23;3(1):e000080.

doi: 10.1136/bmjdrc-2015-000080. eCollection 2015.

Authors

Elizabeth M Magnan¹, Mari Palta², Jane E Mahoney³, Nancy Pandhi⁴, Daniel M Bolt⁵, Jennifer Fink⁶, Robert T Greenlee⁷, Maureen A Smith⁸

Affiliations

¹ Department of Family and Community Medicine , University of California, Davis , Sacramento, California , USA ; Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
² Department of Biostatistics and Medical Informatics , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
³ Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
⁴ Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Family Medicine , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.
⁵ Department of Educational Psychology , University of Wisconsin-Madison , Madison, Wisconsin , USA.
⁶ Department of Health Informatics and Administration , College of Health Sciences , University Wisconsin Milwaukee , Milwaukee, Wisconsin , USA ; Center for Urban Population Health , Milwaukee, Wisconsin , USA ; Aurora Research Institute, Aurora Health Care , Milwaukee, Wisconsin , USA.
⁷ Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation , Marshfield, WI , USA.
⁸ Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Family Medicine , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA ; Department of Surgery , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin , USA.

PMID: 26217492
PMCID: PMC4513351
DOI: 10.1136/bmjdrc-2015-000080

Abstract

Objective: Multimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.

Research design and methods: This is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.

Results: The 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.

Conclusions: Future interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities.

Keywords: Comorbid Condition(s); Health Sciences Research; Outcomes; Quality of Care.

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References

1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
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1. Bayliss EA, Bonds DE, Boyd CM et al. . Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Ann Fam Med 2014;12:260–9. 10.1370/afm.1643 - DOI - PMC - PubMed

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[1] Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

[2] Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

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

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

[5] US Department of Health & Human Services. Multiple chronic conditions—a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. Washington DC: US Department of Health & Human Services, 2010.

[6] US Department of Health & Human Services. Multiple chronic conditions—a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. Washington DC: US Department of Health & Human Services, 2010.

[7] Goodman RA, Boyd C, Tinetti ME et al. . IOM and DHHS meeting on making clinical practice guidelines appropriate for patients with multiple chronic conditions. Ann Fam Med 2014;12:256–9. 10.1370/afm.1646 - DOI - PMC - PubMed

[8] Goodman RA, Boyd C, Tinetti ME et al. . IOM and DHHS meeting on making clinical practice guidelines appropriate for patients with multiple chronic conditions. Ann Fam Med 2014;12:256–9. 10.1370/afm.1646 - DOI - PMC - PubMed

[9] Bayliss EA, Bonds DE, Boyd CM et al. . Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Ann Fam Med 2014;12:260–9. 10.1370/afm.1643 - DOI - PMC - PubMed

[10] Bayliss EA, Bonds DE, Boyd CM et al. . Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Ann Fam Med 2014;12:260–9. 10.1370/afm.1643 - DOI - PMC - PubMed

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The relationship of individual comorbid chronic conditions to diabetes care quality

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The relationship of individual comorbid chronic conditions to diabetes care quality

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Abstract

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