• SeungJin Bae and Meredith B Rosenthal.
• Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA. genice@hiramail.net
• J Gen Intern Med. 2008 Dec 1; 23 (12): 193319391933-9.

BackgroundThe implications of measuring and rewarding performance for patients with multiple chronic conditions have not been explored empirically.ObjectiveTo examine whether the number of chronic conditions was associated with patient's receipt of recommended preventive care.MethodsWe evaluated the association between the likelihood of receiving recommended preventive care and the number of chronic conditions in the diabetic population by analyzing the 2003 Medical Expenditure Panel Survey using logistic regression. Demographic characteristics and the number of chronic conditions were compared using chi(2) tests.Outcome MeasuresHemoglobin A1C test and diabetic eye exam.ResultsIn 2003, approximately 14.2 million non-institutionalized Americans had diabetes and 23% of them had five or more chronic conditions besides diabetes. Those patients were 67% (p < 0.05) and 50% (p < 0.001) more likely to receive hemoglobin A1C test and eye exams compared with diabetic patients with no additional chronic conditions. After adjusting for the number of office-based physician visits, a larger number of chronic conditions did not significantly affect the likelihood of receiving recommended care. Diabetic patients with more chronic conditions had more frequent office-based physician visits (p < 0.0001), and patients with 11 or more annual office-based physician visits were 43% (p < 0.05) and 40% (p < 0.01) more likely to receive hemoglobin A1C test and eye exam, respectively, compared with diabetic patients who had less than two office-based physician visits.ConclusionsDiabetic patients with more chronic conditions may receive better quality of preventive care, partly due to their higher number of office-based physician visits.

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