Burden of comorbid medical conditions and quality of diabetes care
Authors
Halanych, Jewell H.Safford, Monika M.
Keys, Wendy
Person, Sharina D.
Shikany, James M.
Kim, Young-Il
Centor, Robert Maccabbee
Allison, Jeroan J.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2007-08-25Keywords
AgedAlabama
Comorbidity
Cost of Illness
Diabetes Complications
Hemoglobin A, Glycosylated
Humans
Lipids
Medicare
Quality Assurance, Health Care
Reimbursement Mechanisms
United States
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
OBJECTIVE: With performance-based reimbursement pressures, it is concerning that most performance measurements treat each condition in isolation, ignoring the complexities of patients with multiple comorbidities. We sought to examine the relationship between comorbidity and commonly assessed services for diabetic patients in a managed care organization. RESEARCH DESIGN AND METHODS: In 6,032 diabetic patients, we determined the association between the independent variable medical comorbidity, measured by the Charlson Comorbidity Index (CCI), and the dependent variables A1C testing, lipid testing, dilated eye exam, and urinary microalbumin testing. We calculated predicted probabilities of receiving tests for patients with increasing comorbid illnesses, adjusting for patient demographics. RESULTS: A1C and lipid testing decreased slightly at higher CCI: predicted probabilities for CCI quartiles 1, 2, 3, and 4 were 0.83 (95% CI 0.70-0.91), 0.83 (0.69-0.92), 0.82 (0.68-0.91), and 0.78 (0.61-0.88) for A1C, respectively, and 0.82 (0.69-0.91), 0.81(0.67-0.90), 0.79 (0.64-0.89), and 0.77 (0.61-0.88) for lipids. Dilated eye exam and urinary microalbumin testing did not differ across CCI quartiles: for quartiles 1, 2, 3, and 4, predicted probabilities were 0.48 (0.33-0.63), 0.54 (0.38-0.69), 0.50 (0.34-0.65), and 0.50 (0.34-0.65) for eye exam, respectively, and 0.23 (0.12-0.40), 0.24 (0.12-0.42), 0.24 (0.12-0.41), and 23 (0.11-0.40) for urinary microalbumin. CONCLUSIONS: Services received did not differ based on comorbid illness burden. Because it is not clear whether equally aggressive care confers equal benefits to patients with varying comorbid illness burden, more evidence confirming such benefits may be warranted before widespread implementation of pay-for-performance programs using currently available "one size fits all" performance measures.Source
Diabetes Care. 2007 Dec;30(12):2999-3004. Epub 2007 Aug 23. Link to article on publisher's siteDOI
10.2337/dc06-1836Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47692PubMed ID
17717287Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.2337/dc06-1836