Facilitating quality improvement in physician management of comorbid chronic disease in an urban minority practice.
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.
Kahn
Linda S
LS
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
Fox
Chester H
CH
Olawaiye
Adefunke
A
Servoss
Timothy J
TJ
McLean-Plunkett
Elizabeth
E
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*