Impact of clinical complexity on the quality of diabetes care

Authors

LeChauncy D. Woodard, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, United States
Cassie R. Landrum, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, United States
Tracy H. Urech, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, United States
Degang Wang, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, United States
Salim S. Virani, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, United StatesFollow
Laura A. Petersen, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, United States

Document Type

Article

Department

Cardiology

Abstract

Objectives: To assess the impact of clinical complexity on 3 dimensions of diabetes care.
Study design: 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.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

The American Journal of Managed Care

Recommended Citation

Woodard, L. D., Landrum, C. R., Urech, T. H., Wang, D., Virani, S. S., Petersen, L. A. (2012). Impact of clinical complexity on the quality of diabetes care. The American Journal of Managed Care, 18(9), 508-514.
Available at: https://ecommons.aku.edu/provost_office/249