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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.

journal_name

BMC Fam Pract

journal_title

BMC family practice

authors

Magnan EM,Gittelson R,Bartels CM,Johnson HM,Pandhi N,Jacobs EA,Smith MA

doi

10.1186/s12875-015-0253-6

subject

Has Abstract

pub_date

2015-03-28 00:00:00

pages

issn

1471-2296

pii

10.1186/s12875-015-0253-6

journal_volume

pub_type

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Establishing chronic condition concordance and discordance with diabetes: a Delphi study.