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Patients with Multiple Chronic Conditions Do Not Receive Lower Quality of Preventive Care

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Abstract

BACKGROUND

The implications of measuring and rewarding performance for patients with multiple chronic conditions have not been explored empirically.

OBJECTIVE

To examine whether the number of chronic conditions was associated with patient’s receipt of recommended preventive care.

METHODS

We evaluated the association between the likelihood of receiving recommended preventive care and the number of chronic conditions in the diabetic population by analyzing the 2003 Medical Expenditure Panel Survey using logistic regression. Demographic characteristics and the number of chronic conditions were compared using χ2 tests.

OUTCOME MEASURES

Hemoglobin A1C test and diabetic eye exam.

RESULTS

In 2003, approximately 14.2 million non-institutionalized Americans had diabetes and 23% of them had five or more chronic conditions besides diabetes. Those patients were 67% (p < 0.05) and 50% (p < 0.001) more likely to receive hemoglobin A1C test and eye exams compared with diabetic patients with no additional chronic conditions. After adjusting for the number of office-based physician visits, a larger number of chronic conditions did not significantly affect the likelihood of receiving recommended care. Diabetic patients with more chronic conditions had more frequent office-based physician visits (p < 0.0001), and patients with 11 or more annual office-based physician visits were 43% (p < 0.05) and 40% (p < 0.01) more likely to receive hemoglobin A1C test and eye exam, respectively, compared with diabetic patients who had less than two office-based physician visits.

CONCLUSIONS

Diabetic patients with more chronic conditions may receive better quality of preventive care, partly due to their higher number of office-based physician visits.

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References

  1. Garber AM. Evidence-based guidelines as a foundation for performance incentives. Health Aff (Millwood). 2005;24(1):174–9.

    Article  Google Scholar 

  2. Rosenthal MB, Fernandopulle R, Song HR, Landon B. Paying for quality: providers’ incentives for quality improvement. Health Aff (Millwood). 2004;23(2):127–41.

    Article  Google Scholar 

  3. Tinetti ME, Bogardus ST Jr, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004;351(27):2870−4.

    Article  PubMed  CAS  Google Scholar 

  4. Anderson G, Horvath J. The growing burden of chronic disease in America. Public Health Rep. 2004;119(3):263−70.

    Article  PubMed  Google Scholar 

  5. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716−24.

    Article  PubMed  CAS  Google Scholar 

  6. Hofer TP, Zemencuk JK, Hayward RA. When there is too much to do: how practicing physicians prioritize among recommended interventions. J Gen Intern Med. 2004;19(6):646−53.

    Article  PubMed  Google Scholar 

  7. Yarnall KSH, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention. Am J Public Health. 2003;93(4):635−41.

    Article  PubMed  Google Scholar 

  8. Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005;118(3):251–8.

    Article  PubMed  Google Scholar 

  9. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–76.

    Article  PubMed  Google Scholar 

  10. O’Connor PJ. Adding value to evidence-based clinical guidelines. JAMA. 2005;294(6):741–3.

    Article  PubMed  CAS  Google Scholar 

  11. Kiefe CI, Funkhouser E, Fouad MN, May DS. Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med. 1998;13(6):357–65.

    Article  PubMed  CAS  Google Scholar 

  12. Schoen RE, Marcus M, Braham RL. Factors associated with the use of screening mammography in a primary care setting. J Community Health. 1994;19(4):239–52.

    Article  PubMed  CAS  Google Scholar 

  13. Heflin MT, Oddone EZ, Pieper CF, Burchett BM, Cohen HJ. The effect of comorbid illness on receipt of cancer screening by older people. J Am Geriatr Soc. 2002;50(10):1651–8.

    Article  PubMed  Google Scholar 

  14. Bostick RM, Sprafka JM, Virnig BA, Potter JD. Predictors of cancer prevention attitudes and participation in cancer screening examinations. Prev Med. 1994;23(6):816–26.

    Article  PubMed  CAS  Google Scholar 

  15. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2005;28(1):S4–36.

    Article  Google Scholar 

  16. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414–31.

    Article  PubMed  CAS  Google Scholar 

  17. Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med. 1993;328(23):1676–85.

    Article  PubMed  CAS  Google Scholar 

  18. American Diabetes Association. Economic costs of diabetes in the U.S. in 2002. Diabetes Care. 2003;26(3):917–32.

    Article  Google Scholar 

  19. Agency for Healthcare Research and Quality. MEPS HC-079: 2003 Full Year Consolidated Data File. Rockville, MD; 2005 November.

  20. Agency for Healthcare Research and Quality. MEPS HC-078: 2003 Medical Conditions. Rockville, MD; 2005 November.

  21. Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA. 1996;276(18):1473–9.

    Article  PubMed  CAS  Google Scholar 

  22. Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff (Millwood). 2001;20(6):267–78.

    Article  CAS  Google Scholar 

  23. United States Preventive Services Task Force. 2008. Available at http://www.ahrq.gov/clinic/USpstfix.htm Accessed August 20, 2008.

  24. Ferris TG, Blumenthal D, Woodruff PG, Clark S, Camargo CA. Insurance and quality of care for adults with acute asthma. J Gen Intern Med. 2002;17(12):905–13.

    Article  PubMed  Google Scholar 

  25. Rosen AB, Karter AJ, Liu JY, Selby JV, Schneider EC. Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high-risk clinical and ethnic groups with diabetes. J Gen Intern Med. 2004;19(6):669–75.

    Article  PubMed  Google Scholar 

  26. Frayne SM, Halanych JH, Miller DR, et al. Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005;165(22):2631–8.

    Article  PubMed  Google Scholar 

  27. Desai MM, Rosenheck RA, Druss BG, Perlin JB. Mental disorders and quality of diabetes care in the veterans health administration. Am J Psychiatry. 2002;159(9):1584–90.

    Article  PubMed  Google Scholar 

  28. Schectman G, Barnas G, Laud P, Cantwell L, Horton M, Zarling EJ. Prolonging the return visit interval in primary care. Am J Med. 2005;118(4):393–9.

    Article  PubMed  Google Scholar 

  29. Mechanic D, McAlpine DD, Rosenthal M. Are patients’ office visits with physicians getting shorter. N Engl J Med. 2001;344(3):198–204.

    Article  PubMed  CAS  Google Scholar 

  30. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29(3):725–31.

    Article  PubMed  Google Scholar 

  31. Meduru P, Helmer D, Rajan M, Tseng C-L, Pogach L, Sambamoorthi U. Chronic illness with complexity: implications for performance measurement of optimal glycemic control. J Gen Inter Med. 2007;22(Suppl 3):408–18.

    Article  Google Scholar 

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Acknowledgement

This study was financially supported by Harvard School of Public Health institutional funding. Authors are grateful to Dr. Wenke Hwang for sharing the classification system. Helpful comments from Dr. David Kashikara of Agency of Health Care Research and Quality, and Dr. Chapin White of Congressional Budget Office are also greatly appreciated.

Conflicts of interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    SeungJin Bae Sc.D. & Meredith B. Rosenthal Ph.D.

  2. Health Insurance Review & Assessment Service, Seoul, Korea

    SeungJin Bae Sc.D.

Authors
  1. SeungJin Bae Sc.D.
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  2. Meredith B. Rosenthal Ph.D.
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Corresponding author

Correspondence to SeungJin Bae Sc.D..

Additional information

Financial support: Harvard School of Public Health Institutional Funding

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Bae, S., Rosenthal, M.B. Patients with Multiple Chronic Conditions Do Not Receive Lower Quality of Preventive Care. J GEN INTERN MED 23, 1933–1939 (2008). https://doi.org/10.1007/s11606-008-0784-9

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  • DOI: https://doi.org/10.1007/s11606-008-0784-9

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