Abstract:
BACKGROUND:Among patients with type 2 diabetes, it is not known whether risk factor control is better or worse for those who also have heart disease, depression, multiple other comorbidities, and associated management challenges. OBJECTIVE:To examine the relationship between this complex constellation of multimorbidities, adherence to treatment and risk factor control among patients with type 2 diabetes, independent of regimen intensity. RESEARCH DESIGN:Observational cross-sectional study. SUBJECTS:A total of 1314 patients with diabetes from the Reducing Racial Disparities in Diabetes Coached Care (R2D2C2) Study. MEASURES:A composite cardiometabolic risk factor profile was the dependent variable. Independent variables included a composite measure of patient complexity, patient-reported adherence to treatment, history of coronary heart disease (CHD), and intensity of medication regimen. RESULTS:A higher proportion of the most complex patient-reported problems with adherence compared with the least complex patients (83.5% vs. 43.3%, P<0.001). Compared with those without a history of CHD, fewer patients with CHD-reported problems with medication adherence (59.3% vs. 69.3%, P<0.01) and had better risk factor control, independent of complexity and regimen intensity. Better risk factor control was independently associated with less patient complexity (P=0.003) and to history of CHD (P=0.01). CONCLUSIONS:The presence of a complex illness profile was associated with poorer control of risk factors. Those with CHD were more adherent to treatment and had better risk factor control. The occurrence of CHD may present an opportunity for physicians to emphasize risk factor management. Diabetes patients with a complex illness profile may be at highest risk for cardiovascular events and in greatest need of prevention of cardiac disease. TRIAL REGISTRATION:Clinicaltrial.gov identifier: NCT01123239.
journal_name
Med Carejournal_title
Medical careauthors
Malik S,Billimek J,Greenfield S,Sorkin DH,Ngo-Metzger Q,Kaplan SHdoi
10.1097/MLR.0b013e318273119bsubject
Has Abstractpub_date
2013-02-01 00:00:00pages
180-5issue
2eissn
0025-7079issn
1537-1948journal_volume
51pub_type
杂志文章,多中心研究相关文献
MEDICAL CARE文献大全abstract::Clinical Engineers are currently employed in hospitals to see that the more complex instrumentation is electrically safe and well maintained. Such an objective fails to capitalize on the economic advantages which can be derived from specialist management. This paper proposes that the objective be broadened to cover th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197707000-00003
更新日期:1977-07-01 00:00:00
abstract:BACKGROUND:The profile-based SF-12 has a low respondent burden and is used widely in clinical settings to monitor health and evaluate programs. Deriving preference scores for the SF-12 health profile would permit its use in cost-effectiveness analyses. Previous mapping studies of SF family instruments to preference-bas...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000093480.58308.D8
更新日期:2003-11-01 00:00:00
abstract:RATIONALE:Moving patients from low-performing hospitals to high-performing hospitals may improve patient outcomes. These transfers may be particularly important in critical care, where small relative improvements can yield substantial absolute changes in survival. OBJECTIVE:To characterize the existing critical care n...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318197b1f5
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVES:To help resolve the current controversy over the validity of early readmission as an indicator of the quality of care, the authors critically reviewed the literature using meta-analysis to derive summary estimates of effect and evaluate inter-study heterogeneity. METHODS:The authors selected reports meeting...
journal_title:Medical care
pub_type: 杂志文章,meta分析
doi:10.1097/00005650-199710000-00006
更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health. OBJECTIVE:We aimed to conduct an economic analysis of implementin...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001372
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. METHODS:A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk ad...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000065127.88685.7D
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to assess the cost attributable to lost productivity from arthritis and the association between the degree of loss and demographic, disease-related, occupational, and psychosocial variables for people. METHODS:In a prospective study, 383 employed individuals with arthritis wer...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000204257.25875.04
更新日期:2006-04-01 00:00:00
abstract::The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence t...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198206000-00003
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:The effects of continuity of care (COC) on health care outcomes are well established. However, the mechanism of this association is not fully understood. OBJECTIVE:The objective of this study was to examine the relationship between COC and medication adherence, as well as to investigate the mediating effect...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31827da5b9
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries. OBJECTIVES:To examine accuracy of cardiac procedure coding in a...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182329778
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phen...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000729
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:In 1998, the Province of Ontario in Canada adopted price-cap "70/90" regulations whereby the first generic entrant was required to be priced at ≤70% of the associated brand-name product and subsequent generics were priced at ≤90% of the first generic price. The price-caps were further lowered to 50% in 2006 ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000577
更新日期:2016-09-01 00:00:00
abstract::This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199301000-00004
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Having health insurance is usually associated with better access to care and better health outcomes. For patients receiving care at Federally Qualified Health Centers (FQHCs), where care is provided regardless of insurance status, the role health insurance status plays in affecting receipt of ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/mlr.0b013e318190ccac
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:A need exists for adapting existing perioperative risk stratification methods such as the Charlson Comorbidity Index (CCI) for application with hospital administrative data in noncardiac surgery populations. OBJECTIVE:Develop and validate outcome-specific CCIs for predicting inpatient mortality, and cardiac...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000592
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. METHODS:Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318268ac0c
更新日期:2012-12-01 00:00:00
abstract::Substantial differences in the use of pediatric medical resources reinforce the need for identifying and understanding factors that influence the use of medical services for children. This research assesses the simultaneous impact of sociodemographic characteristics, health attitudes and beliefs, psychologic distress,...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198508000-00002
更新日期:1985-08-01 00:00:00
abstract::Previous research has neglected to delineate pediatric nurse practitioner (PNP) roles in tertiary care settings (TCS). New PNP roles have developed as TCS seek cost-effective solutions to providing quality patient care and to meeting new demands for outpatient care. The authors evaluated the roles of 11 PNPs in eight ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198604000-00005
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVES:This study examined factors that affect access to Veterans Administration mental health services. METHODS:Data from national Veterans Affairs databases and the 1990 Decennial Census were used to estimate rates of Veterans Affairs mental health service use in each US county (n = 3,156) among all US veterans ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199804000-00006
更新日期:1998-04-01 00:00:00
abstract::Acceptance by target populations of new programs funded by government is a phenomenon which one should be able to explain with existing innovation theory. In a study of a newly formed group health practice, funded in part by OEO, it is found that a commonly used set of predictors has little utility in explaining indi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197904000-00008
更新日期:1979-04-01 00:00:00
abstract:BACKGROUND:Researchers need valid methods to assess whether patients are taking their antidepressant medications. Two important sources of data on drug exposure are patients' self-reports and pharmacy claims. OBJECTIVE:To compare self-report and claims data for antidepressant exposure. RESEARCH DESIGN:Cross-sectional...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000053019.79054.B6
更新日期:2003-03-01 00:00:00
abstract::In this paper the individual is employed as the unit of analysis to examine the extent to which the use of physician care by beneficiaries insured under the Canadian Medicare program is determined by medical needs and sociodemographic characteristics as opposed to economic considerations. The data were derived from th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198311000-00001
更新日期:1983-11-01 00:00:00
abstract:BACKGROUND:As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems. OBJECTIVES:This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatme...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000215814.01127.ce
更新日期:2006-06-01 00:00:00
abstract::Geriatric rehabilitation is a multidisciplinary set of evaluative, diagnostic, and therapeutic interventions whose purpose is to restore functional ability or enhance residual functional capability in elderly people with disabling impairments. The Boston Working Group on Improving Health Care Outcomes Through Geriatri...
journal_title:Medical care
pub_type:
doi:10.1097/00005650-199706001-00003
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of ma...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200003000-00002
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To compare primary care and traditional Internal Medicine residents in their adherence to preventive medicine guidelines, performance in the management of chronic diseases, and utilization of resources. DESIGN:Prospective cohort study. SETTING:Urban Internal Medicine residency program. PARTICIPANTS:Sixteen...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199908000-00007
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:To assess drug prescribing by primary care physicians in France for various types of conditions, and to identify patterns and risk factors for poor prescribing quality. METHODS:The orders (n = 23,080) written for patients with five target diseases (acute nasopharyngitis, acute tonsillitis, essential hyperten...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199912000-00012
更新日期:1999-12-01 00:00:00
abstract::This paper describes an instrument design effort aimed at measuring patient-satisfaction among older (65 years and over) subscribers of HMOs. The study was conducted in a multi-satellite prepaid group practice in Buffalo, New York. In order to be able to construct a satisfaction measure that would reflect the interest...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198908000-00004
更新日期:1989-08-01 00:00:00
abstract:BACKGROUND:Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions. OBJECTIVE:To quantify the rel...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000342
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Providing collaborative mental health treatment within primary care settings improves depression outcomes and may improve detection of mental disorders. Few studies have assessed the effect of collaborative mental health treatment programs on diagnosis of mental disorders in primary care populations. In 2008...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181e5792b
更新日期:2010-09-01 00:00:00