The effect of incident comorbidities on guideline-concordant chronic disease care

合并症事件对符合指南的慢性病护理的影响

• 批准号: 7534841
• 负责人: ELIZABETH A BAYLISS
• 金额: $ 15.18万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7534841
• 关键词: effect; incident; comorbidities; guideline; concordant

DESCRIPTION (provided by applicant): Most guidelines for care of chronic medical conditions are disease-specific. However, adherence to such guidelines in the face of medical complexity may be impossible to carry out or may result in unintended consequences. Alternatively, guidelines may remain relevant for complex patients, but require alternate care strategies. These situations are not at all well defined. We propose a model that describes how an event from a comorbid condition (such as an exacerbation of a coexisting chronic illness; or the diagnosis of a new comorbidity) can affect guideline-concordant care (GCC) for an index condition. Data on approximately 19,000 subjects will be extracted from electronic databases from Kaiser Permanente Colorado, a not-for profit HMO. We will assess the effect of the comorbidities of new-onset depression, new-onset treatable cancer, and exacerbations of chronic pulmonary disease on the index condition of type-2 diabetes. The primary outcome of interest will be Hemoglobin A1c, and secondary outcomes will be blood pressure control and lipid management. Time-varying multivariate regression techniques and latent class analysis will be used to a) assess both the initial and ongoing effects of each comorbid condition on GCC for the index condition over a 6-year time period; and b) identify a subgroup of patients at risk for poor health outcomes due to inability to achieve GCC. Additional analyses will assess medication adherence as a mediator of inability to achieve GCC. Based on results of these analyses, we will propose both specific adaptations to existing diabetes care guidelines, and alternate care management strategies for complex patients with diabetes, that will be amenable to further investigation. We expect that our recommendations will be relevant to other combinations of chronic conditions as well. Using such a model to describe the attainment of GCC will help identify complex patients at risk for poor health outcomes so that a) guidelines can be appropriately altered to reflect the process-of-care needs of complex patients; b) these populations can be studied in interventional trials to determine the most appropriate care management; and c) we can define the target populations to which newly developed quality measures for complex patient populations may be applied. This information may provide the basis for significantly improving the quality and efficiency of care for a growing and vulnerable segment of the U.S. population.

描述（由申请人提供）：大多数慢性病护理指南都是针对特定疾病的。然而，面对复杂的医疗情况，遵守这些准则可能是不可能的，或者可能导致意想不到的后果。另外，指南可能仍然适用于复杂的患者，但需要替代的护理策略。这些情况根本没有得到很好的定义。