Chronic diseases

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

Dr. Elizabeth Magnan et al. sought to determine the impact of the number of concordant and discordant chronic conditions on diabetes care quality. Using EHR data, authors found that a higher number of concordant conditions were associated with higher odds of achieving testing and control goals for all outcomes except blood pressure control. Having more concordant conditions makes diabetes care goal achievement more likely.

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Blood sugar monitor and pills

Establishing chronic condition concordance and discordance with diabetes

Establishing chronic condition concordance and discordance with diabetes

This study by Dr. Elizabeth Magnan et al. aimed to determine which chronic conditions are concordant and discordant with diabetes care. Using the Delphi technique, the study team surveyed PCPs in an academic practice. They found 12 conditions were concordant with diabetes care and 50 were discordant, and 31 of the discordant conditions did not overlap with any of the diabetes care goals. This study adds information that may prove useful in developing multimorbidity guidelines and interventions.

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Woman reviewing results with doctor

Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors

Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors

Dr. Heather Neuman et al. studied current patterns of oncologist breast cancer follow-up to determine the association between patient and tumor characteristics and follow-up frequency. Using SEER-Medicare data, the authors found young age, positive nodes, estrogen/progesterone receptor positivity, and increasing treatment intensity were most strongly associated with more frequent follow-up. Number and types of oncologists also were associated with different follow-up frequencies. 

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Health team

PAs and NPs perform effective roles on teams caring for Medicare patients with diabetes

PAs and NPs perform effective roles on teams caring for Medicare patients with diabetes

Christine Everett et al. used Medicare claims and EHR data from a large physician group to compare outcomes for patients with diabetes with various levels of complexity. Outcomes were generally equivalent for care teams with PAs or NPs and those with physicians only. Findings suggest that patient characteristics as well as goals should be considered when determining how to deploy PAs and NPs on primary care teams.

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Doctors and nurses

Division of primary care services between physicians, PAs, and NPs for older patients with diabetes

Division of primary care services between physicians, PAs, and NPs for older patients with diabetes

Using Medicare claims and EHR data from a large physician group, Christine Everett et al. looked at how to incorporate physician assistants and nurse pracitioners (PA/NPs) into primary care teams. This article describes the division of patients and services between PCPs for older diabetes patients on panels with varying levels of PA/NP involvement. Panels with PA/NP providers had higher proportions of patients with Medicaid, disability, and depression. 

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Doctor writing order

Predictors of colorectal cancer screening variation among primary care providers and clinics

Predictors of colorectal cancer screening variation among primary care providers and clinics

Dr. Jennifer Weiss et al. used EMR data and a survey of primary care providers (PCPs) to evaluate patient, provider, and clinic factors that predict variation in colorectal cancer (CRC) screening among PCPs and clinics. They found that screening rates varied from 51-80% among clinics from 51-82% among PCPs, and identified significant predictors of completing CRC screening at the patient, provider, and clinic level, indicating that quality improvement interventions addressing CRC screening should be addressed at multiple levels of the health care system.

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Reviewing a report

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

Investigators analyzed 14 publicly reported quality of care ambulatory measures for the Wisconsin Collaborative for Healthcare Quality to learn whether the reports impact quality of care for patients. Physician groups in the collaborative improved their performance during the study period and when surveyed, reported that the public measures motivated them to act on some, but not all, of the quality measures. 

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Lipid test checklist and vial of blood

Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities

Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities

Annual lipid testing is recommended to reduce morbidity and mortality for patients with rheumatoid arthritis and comorbid cardiovascular disease, diabetes, or hyperlipidemia. Dr. Christie Bartels et al. used Chronic Conditions Warehouse data to examine the extent to which lipid testing was performed among patients over 65 years old with rheumatoid arthritis and found that although 90% of the patients had cardiovascular disease, 64% had hyperlipidemia, and 46% had diabetes, annual lipid testing was only performed in 63% of the patients. Additionally, 30% of patients saw a primary care provider less than once per year, and those patients were 16% less likely to have lipid testing. Patients who were older, had higher complexity scores, more hospitalizations, and lived in a large town were also less likely to receive lipid testing.

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Man getting blood drawn

Monitoring diabetes in patients with and without rheumatoid arthritis

Monitoring diabetes in patients with and without rheumatoid arthritis

Diabetes mellitus is an important predictor of mortality in patients with rheumatoid arthritis (RA), and both diseases increase the risk of cardiovascular disease. In this study, Dr. Christie Bartels et al. identified patients 65 years or older who had diabetes and examined whether they had comorbid RA and whether they received guideline recommended A1c and lipid testing. They found that among the patients with diabetes, 2% had RA, and those with comorbid RA were more likely to have baseline cardiovascular disease, diabetes-related complications, lower extremity ulcers, and peripheral vascular disease. The patients with RA were less likely to receive recommended A1c testing, but were slightly more likely to receive lipid testing.

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Graphs and phone

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups

This Health Affairs article by Dr. Maureen Smith et al. examined how physician groups respond to public reporting. The authors found that publicly reported metrics, along with participation in large or externally sponsored projects, increased a clinic's implementation of diabetes improvement interventions. Accountability metrics should be structured to capture incremental improvements in quality to reward early and ongoing improvement activities. 

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