Are Co-Morbidities Associated with Guideline Adherence? The MI-Plus Study of Medicare Patients

ABSTRACT BACKGROUND/OBJECTIVES The impact of co-morbid illnesses on adherence to guideline recommendations in chronic illness is of growing concern. We tested a framework [Piette and Kerr, Diabetes Care. 29(3):725–31, 2006 ] of provider adherence to guidelines in the presence of co-morbid conditions...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2009-11, Vol.24 (11), p.1205-1210
Main Authors: Sales, Anne E., Tipton, Edmund F., Levine, Deborah A., Houston, Thomas K., Kim, Yongin, Allison, Jeroan, Kiefe, Catarina I.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Cardiology. Vascular system
Comorbidity
Coronary heart disease
Epidemiology
Female
General aspects
Guideline Adherence - standards
Health behavior
Heart
Heart attacks
Humans
Hyperlipidemias - epidemiology
Hyperlipidemias - therapy
Hypertension - epidemiology
Hypertension - therapy
Internal Medicine
Male
Medical sciences
Medicare
Medicare - standards
Medicine
Medicine & Public Health
Morbidity
Myocardial Infarction - epidemiology
Myocardial Infarction - therapy
Older people
Original
Original Article
Physicians, Family - standards
Practice Guidelines as Topic - standards
Predictive Value of Tests
Public health. Hygiene
Public health. Hygiene-occupational medicine
United States - epidemiology
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Summary:ABSTRACT BACKGROUND/OBJECTIVES The impact of co-morbid illnesses on adherence to guideline recommendations in chronic illness is of growing concern. We tested a framework [Piette and Kerr, Diabetes Care. 29(3):725–31, 2006 ] of provider adherence to guidelines in the presence of co-morbid conditions, which suggests that the effect of co-morbid conditions depends on treatment recommendations for the co-morbid conditions and how symptomatic they are. METHODS We conducted an exploratory analysis to assess the framework using chart audit data for 1,240 post-acute myocardial infarction (AMI) Medicare beneficiaries in Alabama. We assessed level of guideline-adherent post-AMI care from chart-based quality indicators and constructed scores reflecting how much care for the co-morbid condition was similar to post-AMI care (concordance) and how symptomatic the co-morbid condition is, based on expert opinion. RESULTS Patients had a mean age of 74 years, mean co-morbidities of 2, and 61% were white. Both concordance and symptomatic scores were positively associated with guideline compliance, with correlations of 0.32 and 0.14, respectively (p 
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-009-1096-4