Relationship between Number of Medical Conditions and Quality of Care

Higashi, Takahiro; Wenger, Neil S.; Adams, John; Fung, Constance H.; Roland, Martín; McGlynn, Elizabeth A.; Reeves, David; Asch, Steven M.; Kerr, Eve A.; Shekelle, Paul G

doi:10.1056/nejmsa066253

Cited by 232 publications

(193 citation statements)

References 30 publications

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“…Importantly, this association remains robust even when taking into account prior hospitalizations, as well as other indicators of greater patient complexity that could also increase the risk of ACSC-related hospitalization, such as increased age, greater medical comorbidity, poor glucose control and history of alcohol abuse. 32,33 Since hospitalization for an ACSC implies a breakdown in the quality of, and/or access to, primary care, 7,10 our findings suggest that patients with comorbid diabetes and probable major depression may represent a population at particular risk for the declining health status that an ACSC-related hospitalization indicates. 34 Similar to other chronic medical illnesses, diabetes and comorbid mental disorders such as major depression are bidirectionally related.…”

Section: Discussionmentioning

confidence: 81%

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

et al. 2013

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BACKGROUND: Hospitalizations for ambulatory caresensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden. OBJECTIVE: To examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes. DESIGN: Secondary analysis of data from a prospective cohort study. PARTICIPANTS: Population-based cohort of 4,128 patients with diabetes ≥ 18 years old seen in primary care, who were enrolled between 2000 and 2002 and followed for 5 years (through 2007). MAIN MEASURES: Depressive symptoms were assessed with the Patient Health Questionnaire-9. Outcomes of interest included time to initial hospitalization for an ACSC and total number of ACSC-related hospitalizations. We used Cox proportional hazards regression models to ascertain an association between probable major depression and time to ACSC-related hospitalization, as well as Poisson regression for models examining probable major depression and number of ACSC-related hospitalizations. KEY RESULTS: Patients' mean age at study enrollment was 63.4 years (Standard Deviation: 13.4 years). Over the 5-year follow-up period, 981 patients in the study were hospitalized a total of 1,721 times for an ACSC, comprising 45.1 % of all hospitalizations. After adjusting for baseline demographic, clinical and health-risk behavioral factors, probable major depression was associated with initial ACSC-related hospitalization (Hazard Ratio: 1.41, 95 % Confidence Interval [95 % CI]: 1.15, 1.72) and number of ACSC-related hospitalizations (Relative Risk: 1.37, 95 % CI: 1.12, 1.68). CONCLUSIONS: Probable major depression in patients with diabetes is independently associated with hospitalization for an ACSC. Additional research is warranted to ascertain if effective interventions for depression in patients with diabetes could reduce the risk of hospitalizations for ACSCs and their associated adverse outcomes.

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Section: Discussionmentioning

confidence: 81%

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

et al. 2013

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“…While some studies have found that higher comorbidity burden is associated with better quality of care, 32,33 this relationship is inconsistent 34 and appears to vary substantially depending on a patient's specific conditions and combinations of conditions. 35 Several studies have documented quality of care deficiencies when patients have discordant or unrelated comorbidities.…”

Section: The Relationship Between Multimorbidity and Quality Of Carementioning

confidence: 99%

“…Multimorbid patients tend to have frequent and intensive contact with the health care system, 1,9 resulting in more opportunities to monitor each of their conditions, adjust their treatment regimens, and assess their general health maintenance needs. 32,41 At the same time, each additional condition generates opportunities for suboptimal management, including missed diagnoses, inadequate treatment, and access and communication barriers. If a patient has conditions that are unrelated or discordant, there may be insufficient time or competing demands during a visit, 31,37,42 and the patient and his or her provider may disagree about which condition should be prioritized.…”

Section: The Relationship Between Multimorbidity and Quality Of Carementioning

confidence: 99%

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

et al. 2013

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Multimorbidity-the presence of multiple chronic conditions in a patient-has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient's number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions.

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“…These age-related patterns may partly be explained by biographical influences, the differential impact of stress and resilience factors in different age groups, higher proportions of atypical types of depression that are less likely to be identified by the used measures or simply age-related information bias Mauz and Jacobi, 2008;. Also, age-related differences in the use of health care services may influence the prevalence of self-reported diagnosed depression as older people may come into contact with their GP due to other physical complaints (Higashi et al, 2007) and the GP may briefly refer to psychosocial factors (Holvast et al, 2012) thereby providing an opportunity for mental health assessment. Furthermore, older people may be more inclined to report that mental health problems have been discussed (Holvast et al, 2012) and communicate a diagnosis of depression to interviewers.…”

Section: Socio-demographic Correlatesmentioning

confidence: 99%

Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany

Maske

Buttery

Beesdo‐Baum

et al. 2016

Journal of Affective Disorders

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Relationship between Number of Medical Conditions and Quality of Care

Abstract: The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases.

Cited by 232 publications

References 30 publications

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany

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