title: Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  Using 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.
  
  
  RESULTS
  Sixteen 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Department of Family and Community Medicine, University of California, Davis, UC Davis School of Medicine, 4860 Y street, suite 2320, Sacramento, CA, 95817, USA. elizabeth.magnan@ucdmc.ucdavis.edu.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. elizabeth.magnan@ucdmc.ucdavis.edu.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Magnan
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. rgittel@live.unc.edu.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gittelson
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. cb4@medicine.wisc.edu.|Department of Medicine, University of Wisconsin, Madison, WI, USA. cb4@medicine.wisc.edu.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. hm2@medicine.wisc.edu.|Department of Medicine, University of Wisconsin, Madison, WI, USA. hm2@medicine.wisc.edu.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Johnson
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. nancy.pandhi@fammed.wisc.edu.|Department of Family Medicine, University of Wisconsin, Madison, WI, USA. nancy.pandhi@fammed.wisc.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. eajacobs@medicine.wisc.edu.|Department of Medicine, University of Wisconsin, Madison, WI, USA. eajacobs@medicine.wisc.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive Suite 210, Madison, WI, 53705, USA. maureensmith@wisc.edu.|Department of Family Medicine, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.|Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.|Department of Surgery, University of Wisconsin, Madison, WI, USA. maureensmith@wisc.edu.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy*; D015897:Comorbidity; D003697:Delphi Technique; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D058005:General Practitioners; D019538:Health Care Surveys; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care