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Stratifying Patients with Diabetes into Clinically Relevant Groups by Combination of Chronic Conditions to Identify Gaps in Quality of Care
- Source :
- Health services research, vol 53, iss 1
- Publication Year :
- 2016
- Publisher :
- Wiley, 2016.
-
Abstract
- Objective To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics. Data Sources/Study Setting Twenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010–2011. Study Design We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions (“classes”) based on condition co-occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization. Data Collection We extracted electronic health record data using a standardized algorithm. Principal Findings We found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7–2.2), 1.6 (1.4–1.9), 1.3 (1.2–1.5), and 1.3 (1.2–1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics. Conclusions Patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.
- Subjects :
- Male
Glycated Hemoglobin A
Policy and Administration
Kidney Function Tests
Cardiovascular
Logistic regression
Severity of Illness Index
0302 clinical medicine
Risk Factors
Electronic Health Records
030212 general & internal medicine
Health Policy
Diabetes
Middle Aged
Cholesterol
Heart Disease
Cardiovascular Diseases
quality
Public Health and Health Services
Health Policy & Services
Female
Metric (unit)
Adult
medicine.medical_specialty
multimorbidity
public reporting
030209 endocrinology & metabolism
LDL
Diabetes Complications
7.3 Management and decision making
Young Adult
03 medical and health sciences
Clinical Research
Internal medicine
Diabetes mellitus
Diabetes Mellitus
medicine
Humans
Obesity
Quality of care
Metabolic and endocrine
Retrospective Studies
Aged
Quality of Health Care
Glycemic
Glycated Hemoglobin
Data collection
business.industry
Prevention
multiple chronic conditions
Cholesterol, LDL
Odds ratio
medicine.disease
United States
Confidence interval
Logistic Models
Good Health and Well Being
Chronic Disease
Primary Care and Chronic Disease Management
Physical therapy
Management of diseases and conditions
business
Subjects
Details
- ISSN :
- 00179124
- Volume :
- 53
- Database :
- OpenAIRE
- Journal :
- Health Services Research
- Accession number :
- edsair.doi.dedup.....4a6aa57caccf4373bcec1ec1bbee8d91