Abstract
BackgroundThe vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of care; however, clinical practice guidelines, interventions, and public reporting metrics do not adequately address the interaction of these multiple conditions. To advance the understanding of diabetes clinical care in the context of multiple chronic conditions, we must understand how care overlaps, or doesn’t, between diabetes and its co-occurring conditions. This study aimed to determine which chronic conditions are concordant (share care goals with diabetes) and discordant (do not share care goals) with diabetes care, according to primary care provider expert opinion.MethodsUsing the Delphi technique, we administered an iterative, two-round survey to 16 practicing primary care providers in an academic practice in the Midwestern USA. The expert panel determined which specific diabetes care goals were also care goals for other chronic conditions (concordant) and which were not (discordant). Our diabetes care goals were those commonly used in quality reporting, and the conditions were 62 ambulatory-relevant condition categories.ResultsSixteen experts participated and all completed both rounds. Consensus was reached on the first round for 94% of the items. After the second round, 12 conditions were concordant with diabetes care and 50 were discordant. Of the concordant conditions, 6 overlapped in care for 4 of 5 diabetes care goals and 6 overlapped for 3 of 5 diabetes care goals. Thirty-one discordant conditions did not overlap with any of the diabetes care goals, and 19 overlapped with only 1 or 2 goals.ConclusionsThis study significantly adds to the number of conditions for which we have information on concordance and discordance for diabetes care. The results can be used for future studies to assess the impact of concordant and discordant conditions on diabetes care, and may prove useful in developing multimorbidity guidelines and interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0253-6) contains supplementary material, which is available to authorized users.
Highlights
The vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of care; clinical practice guidelines, interventions, and public reporting metrics do not adequately address the interaction of these multiple conditions
Public reporting metrics are derived from clinical care guidelines, and the presence of public reporting metrics can shape clinical care, so it is valuable to understand the influence of multiple chronic conditions on diabetes care in order to have meaningful quality reports [11,12]
It could not be used to discriminate between conditions based on diabetes concordance, and was excluded from use in determining overall condition concordance
Summary
The vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of care; clinical practice guidelines, interventions, and public reporting metrics do not adequately address the interaction of these multiple conditions. Patients with more chronic conditions has been shown in some studies to have better or similar care as Currently, we are limited in our knowledge of which comorbidities may improve or inhibit optimal diabetes care [7,8]. We need to understand the interaction between chronic conditions in order to provide adequate care for patients with diabetes and multimorbidity [8]. Effective interventions in multiple chronic conditions are limited, with few evidence-based interventions that target patients with a specific, rather than general, combination of conditions, such as diabetes plus specific comorbidities [14]. Understanding the interaction between the care for diabetes and specific comorbidities might help in the development of tailored interventions
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