1 / 7

Complex Medical Patients

Complex Medical Patients. Wayne Katon, MD. Challenge: Development of Health Services Models for “Natural” Clusters of Illness. Definition: Illnesses with high prevalence, high comorbidity and bidirectional adverse interactions Examples: Diabetes, CAD, depression

catrin
Download Presentation

Complex Medical Patients

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Complex Medical Patients Wayne Katon, MD

  2. Challenge: Development of Health Services Models for “Natural” Clusters of Illness • Definition: Illnesses with high prevalence, high comorbidity and bidirectional adverse interactions • Examples: • Diabetes, CAD, depression • Depression, chronic pain, substance abuse

  3. Pitfalls of Processes of Care Measures • Many measures of processes of care lack strong links to outcomes • Actionable processes of care are not measured • Measures do not target those at highest risk • Measures do not allow for patient exceptions • Intermediate outcome measures are not severity adjusted Kerr E et al. 2001

  4. “Tightly Linked” Quality of Care Measures • Evidence links these process measures to improved outcomes • Adding a beta-blocker to HCTZ in patients with poorly controlled blood pressure Kerr E et al. 2001

  5. 161,697 Patients with Diabetes were Examined to Estimate Rates and Reasons for Poor Disease Control (HbA1c, SBP, LDLs) • 20% to 23% poor adherence • Among those with adequate adherence, 30% to 47% had no evidence of treatment intensification • Poor adherence and lack of treatment intensification were found in 53% to 68% of patients with poor disease control Schmittdiel J et al. 2008

  6. Comorbid Depression & Diabetes Adversely affects self-care: adherence to diet, exercise, cessation of smoking, taking medications as prescribed Comorbid Depression & Diabetes • Does not affect quality of care measures under more direct physician control): • Number of HbA1c, LDL tests, annual retinal and foot exams • Intensification of medication in patients with poor disease control

  7. ACCORD, ADVANCE and VADT Trials • Limited evidence that intensive glucose control decreased macrovascular events • Subset analysis suggested that patients with shorter duration of diabetes without established atherosclerosis might benefit from intensive glucose control • Risks of intensive glucose control might outweigh benefits in those with a long history of diabetes, known history of hypoglycemia, advanced atherosclerosis and advanced age/fragility Skyleret al. 2009

More Related