Impact of clinical complexity on the quality of diabetes care.
Am J Manag Care
; 18(9): 508-14, 2012 09.
Article
em En
| MEDLINE
| ID: mdl-23009301
ABSTRACT
OBJECTIVES:
To assess the impact of clinical complexity on 3 dimensions of diabetes care. STUDYDESIGN:
We identified 35,872 diabetic patients receiving care at 7 Veterans Affairs facilities between July 2007 and June 2008 using administrative and clinical data. We examined control at index and appropriate care (among uncontrolled patients) within 90 days, for blood pressure (<130/80 mm Hg), glycated hemoglobin (<7%), and low-density lipoprotein cholesterol (<100 mg/dL). We used ordered logistic regression to examine the impact of complexity, defined by comorbidities count and illness burden, on control at index and a combined measure of quality (control at index or appropriate follow-up care) for all 3 measures.RESULTS:
There were 6260 (17.5%) patients controlled at index for all 3 quality indicators. Patients with >3 comorbidities (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.67-2.26) and illness burden >2.00 (OR, 1.22; 95% CI, 1.13-1.32) were more likely than the least complex patients to be controlled for all 3 measures. Patients with >3 comorbidities (OR, 2.30; 95% CI, 2.07-2.54) and illness burden >2.00 (OR, 1.25; 95% CI, 1.18-1.33) were also more likely than the least complex patients to meet the combined quality indicator for all 3 measures.CONCLUSIONS:
Patients with greatest complexity received higher quality diabetes care compared with less complex patients, regardless of the definition of complexity chosen. Although providers may appropriately target complex patients for aggressive control, deficits in guideline achievement among all diabetic patients highlight the challenges of caring for chronically ill patients and the importance of structuring primary care to promote higher-quality, patient-centered care.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Resolução de Problemas
/
Qualidade da Assistência à Saúde
/
Diabetes Mellitus
Tipo de estudo:
Etiology_studies
/
Guideline
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article