Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list.
BACKGROUND
Primary care physicians are caring for increasing numbers of persons with comorbid chronic illness. Longitudinal information on health outcomes associated with specific chronic conditions may be particularly relevant in caring for these populations. Our objective was to assess the effect of certain comorbid conditions on physical well being over time in a population of persons with chronic medical conditions; and to compare these effects to that of hypertension alone.


METHODS
We conducted a secondary analysis of 4-year longitudinal data from the Medical Outcomes Study. A heterogeneous population of 1574 patients with either hypertension alone (referent) or one or more of the following conditions: diabetes, coronary artery disease, congestive heart failure, respiratory illness, musculoskeletal conditions and/or depression were recruited from primary and specialty (endocrinology, cardiology or mental health) practices within HMO and fee-for-service settings in three U.S. cities. We measured categorical change (worse vs. same/better) in the SF-36(R) Health Survey physical component summary score (PCS) over 4 years. We used logistic regression analysis to determine significant differences in longitudinal change in PCS between patients with hypertension alone and those with other comorbid conditions and linear regression analysis to assess the contribution of the explanatory variables.


RESULTS
Specific diagnoses of CHF, diabetes and/or chronic respiratory disease; or 4 or more chronic conditions, were predictive of a clinically significant decline in PCS.


CONCLUSIONS
Clinical recognition of these specific chronic conditions or 4 or more of a list of chronic conditions may provide an opportunity for proactive clinical decision making to maximize physical functioning in these populations.
Bayliss
Elizabeth A
EA
Department of Family Medicine, University of Colorado Health Sciences Center, Denver, CO, USA. Elizabeth.Bayliss@KP.org
Bayliss
Martha S
MS
Ware
John E
JE
Steiner
John F
JF
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D002641:Chicago / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D008137:Longitudinal Studies; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008511:Medicine; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011320:Primary Health Care; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D018434:Sickness Impact Profile; D013038:Specialization