Impact of comorbidity type on measures of quality for XXXX care.

@entity1 @entity407 @entity308 @entity101 @entity6 @entity625 @entity102 @entity741 @entity165
OBJECTIVE: Studies provide conflicting results about the impact of comorbid conditions on the quality of @entity102 care. We assessed the effect of comorbidity type (concordant, discordant, or both) on the receipt of guideline-recommended care among @entity1 with @entity6 . RESEARCH DESIGN: @entity1 were assigned to 1 of 4 condition groups: @entity6 -concordant ( @entity101 , @entity741 , @entity407 ), and/or @entity6 -discordant ( @entity625 , @entity308 , chronic obstructive pulmonary disease) conditions, or neither. We evaluated hemoglobin A1c, blood pressure, and low-density lipoprotein @entity165 readings at index and measured overall good quality of @entity6 care, including a 6-month follow-up interval. We assessed the effect of condition group on overall good quality of care with logistic regression and generalized ordered logistic regression. RESULTS: We assigned 35,872 @entity1 to the @entity6 comorbid condition groups, ranging from 2.0% in the discordant-only group to 58.0% in the concordant-only group. @entity1 with both types of conditions were more likely than those with no comorbidities to receive overall good quality for glycemic [odds ratio (OR), 2.13; 95% confidence interval (CI), 1.86-2.41], blood pressure (OR, 1.62; 95% CI, 1.40-1.84), and low-density lipoprotein @entity165 (OR, 3.57; 95% CI, 3.08-4.05) control within 6 months of an index visit. They were also more likely to receive overall good quality for all 3 quality measures combined (OR, 2.17; 95% CI, 1.96-2.39). CONCLUSIONS: @entity1 with the greatest clinical complexity were more likely than less complex @entity1 to receive high quality @entity6 care, suggesting that increased complexity does not necessarily predispose chronically ill @entity1 to receiving poorer care. However, caution should be used in treating certain @entity1 groups, such as the elderly, for whom adherence to multiple condition-specific guidelines may lack benefit or cause harm.
