Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Vogeli, Christine; Shields, Alexandra E.; Lee, Todd A.; Gibson, Teresa B.; Marder, William D.; Weiss, Kevin B.; Blumenthal, David

doi:10.1007/s11606-007-0322-1

Cited by 915 publications

(736 citation statements)

References 44 publications

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“…40,41 However, tailored strategies such as clinical decision support are needed to assist providers and patients with complex comorbidity management. 42 One of the limitations of this study is the use of data from a single healthcare system, potentially limiting the generalizability. However, this healthcare system is one of the ten largest physician practices in the United States, with primary care clinics in both urban and rural settings.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

et al. 2015

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BACKGROUND: Early hypertension control reduces the risk of cardiovascular complications among patients with diabetes mellitus. There is a need to improve hypertension management among patients with diabetes mellitus. OBJECTIVE: We aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. DESIGN: This was a 4-year retrospective analysis of electronic health records. PARTICIPANTS: Adults ≥18 years old (n=771) with diabetes mellitus, who met criteria for incident hypertension and received primary care at a large, Midwestern academic group practice from 2008 to 2011 were included MAIN MEASURES: Cut-points of 130/80 and 140/ 90 mmHg were used to identify incident cases of hypertension. Kaplan-Meier analysis estimated the probability of receiving: 1) an initial hypertension diagnosis and 2) antihypertensive medication at specific time points. Cox proportional-hazard frailty models (HR; 95 % CI) were fit to identify associations of time to hypertension diagnosis and treatment. KEY RESULTS: Among patients with diabetes mellitus who met clinical criteria for hypertension, 41 % received a diagnosis and 37 % received medication using the 130/ 80 mmHg cut-point. At the 140/90 mmHg cut-point, 52 % received a diagnosis and 49 % received medication. Atrial fibrillation (HR 2.18; 1.21-4.67) was associated with faster diagnosis rates; peripheral vascular disease (HR 0.18; 0.04-0.74) and fewer primary care visits (HR 0.93; 0.88-0.98) were associated with slower diagnosis rates. Atrial fibrillation (HR 3.07; 1.39-6.74) and ischemic heart disease/congestive heart failure (HR 2.16; 1.24-3.76) were associated with faster treatment rates; peripheral vascular disease (HR 0.16;) and fewer visits (HR 0.93;) predicted slower medication initiation. Diagnosis and treatment of incident hypertension were similar using cut-points of 130/80 and 140/90 mmHg. CONCLUSIONS: Among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 % remained undiagnosed and untreated for hypertension. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes clinical care.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

et al. 2015

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“…1 The prevalence of chronic conditions and multimorbidity will increase and associated healthcare expenditures will continue to rise. [2][3][4] Modifiable behaviors such as at-risk alcohol consumption will need to be identified as a component of patient-centered, comprehensive primary care. Excessive alcohol use can exacerbate chronic medical conditions.…”

Section: Introductionmentioning

confidence: 99%

Drinking Patterns of Older Adults with Chronic Medical Conditions

et al. 2013

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BACKGROUND: Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population. OBJECTIVES: To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions. DESIGN/METHODS: This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n=7,422). Based on selfreported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines). RESULTS: Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking. CONCLUSIONS: Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.

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“…The scope of nursing is so extensive that each nurse knows only a small part of it. Nevertheless, a person often has multiple medical situations and requires a wide range of healthcare information (e.g., 21% Americans have multiple chronic conditions [27]). Moreover, healthcare information keeps updating rapidly and no nurse can always keep up with the latest ones.…”

Section: Related Workmentioning

confidence: 99%

Automatic Home Medical Product Recommendation

2010

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Web-based personal health records (PHRs) are being widely deployed. To improve PHR's capability and usability, we proposed the concept of intelligent PHR (iPHR). In this paper, we use automatic home medical product recommendation as a concrete application to demonstrate the benefits of introducing intelligence into PHRs. In this new application domain, we develop several techniques to address the emerging challenges. Our approach uses treatment knowledge and nursing knowledge, and extends the language modeling method to (1) construct a topic-selection input interface for recommending home medical products, (2) produce a global ranking of Web pages retrieved by multiple queries, and (3) provide diverse search results. We demonstrate the effectiveness of our techniques using USMLE medical exam cases.

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Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Cited by 915 publications

References 44 publications

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

Drinking Patterns of Older Adults with Chronic Medical Conditions

Automatic Home Medical Product Recommendation

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