title: Facilitating quality improvement in physician management of comorbid chronic disease in an urban minority practice.
abstract: BACKGROUND
  Increasing numbers of patients with multiple chronic conditions present in the primary care setting and pose a challenge to physicians who must cope with competing demands while adhering to clinical practice guidelines.
  
  
  OBJECTIVE
  We tested a chart audit tool to assess how physicians are managing patients with multiple comorbidities in an inner-city family medicine practice serving minority patients.
  
  
  METHODS
  We developed an evidence-based comorbidity chart audit tool that captures the number of diagnosed, coexisting general medical conditions and adherence to key clinical practice guidelines for each condition. A randomized chart audit was undertaken, with one in every five charts selected, yielding a total of 314 patient charts.
  
  
  RESULTS
  The majority of patients (59%) had > or = 2 comorbid chronic conditions, and 32% had > or = 3 comorbid chronic conditions. The highest overall adherence to guidelines was for chronic obstructive pulmonary disease (90%) and asthma (80%), followed by congestive heart failure (75%) and coronary artery disease (58%). For all other conditions, overall adherence to guidelines was < or = 50%.
  
  
  CONCLUSIONS
  The chart review tool identified inconsistencies in adherence to guidelines across multiple diagnosed conditions, suggesting the importance of adopting a patient-centered approach to management as well as prevention.
authors: Family Medicine Research Institute, Department of Family Medicine, School of Medicine and Biomedical Sciences, SUNY Clinical Center, State University of New York at Buffalo, Buffalo, NY 14215, USA. lskahn@buffalo.edu
authors: Linda S
authors: LS
authors: Kahn
authors: Chester H
authors: CH
authors: Fox
authors: Adefunke
authors: A
authors: Olawaiye
authors: Timothy J
authors: TJ
authors: Servoss
authors: Elizabeth
authors: E
authors: McLean-Plunkett
mesh_terms: D001741:Black or African American; D000368:Aged; D002908:Chronic Disease / Q000208:ethnology* / Q000517:prevention & control*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010865:Pilot Projects; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D019037:Urban Health Services / Q000592:standards*