title: Stratifying Patients with Diabetes into Clinically Relevant Groups by Combination of Chronic Conditions to Identify Gaps in Quality of Care.
abstract: To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics.
  
  
  
  Twenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010-2011.
  
  
  
  We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions ("classes") based on condition co-occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization.
  
  
  
  We extracted electronic health record data using a standardized algorithm.
  
  
  
  We found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7-2.2), 1.6 (1.4-1.9), 1.3 (1.2-1.5), and 1.3 (1.2-1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics.
  
  
  
  Patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.
authors.affiliation: Department of Family and Community Medicine, University of California, Davis, 4860 Y Street, Suite 2320, Sacramento, CA, 95817.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Magnan
authors.affiliation: Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bolt
authors.affiliation: Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, WI.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Greenlee
authors.affiliation: Department of Health Informatics and Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI.|Center for Urban Population Health, Milwaukee, WI.|Aurora Research Institute, Aurora Health Care, Milwaukee, WI.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fink
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI.|Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.|Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.|Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D002908:Chronic Disease / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000145:classification / Q000453:epidemiology* / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011787:Quality of Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: Diabetes; multimorbidity; multiple chronic conditions; public reporting; quality