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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3069 — Association between Patient-Centered Care and Quality of Chronic Illness Care among Veterans with Multimorbidity

Woodard LD, Michael E. DeBakey VA Medical Center and Baylor College of Medicine; Landrum CR, Michael E. DeBakey VA Medical Center; Hysong SJProfit JWang DPetersen LASansgiry S, and Naik AD, Michael E. DeBakey VA Medical Center and Baylor College of Medicine;

Clinical practice guidelines often focus on individual conditions and thus, may fail to account for patient preferences and to fully reflect the complexity of caring for multimorbid patients. Therefore, as currently structured, guidelines may inadvertently promote less patient-centered care. We assessed the association between guideline-recommended care for blood pressure, glycemic, and lipid control, and self -reported patient-centered care in a cohort of Veterans with multimorbidity.

Using VA administrative data, we identified patients receiving care at a large, urban VA Medical Center from November-December 2010 with coexisting hypertension, ischemic heart disease, and diabetes. We mailed 387 self-administered surveys to those meeting study eligibility criteria. We measured patient-centered care using the Patient Assessment of Chronic Illness Care (PACIC). We reviewed medical records to obtain diagnoses, laboratory values, and vital signs. We used linear regression to examine the association between PACIC scores and guideline-recommended levels of blood pressure (BP), (<130/80 mm Hg and <140/90 mm Hg), hemoglobin (Hb) A1c (<= 9% and <7%), and low-density lipoprotein cholesterol (LDL-C <100 mg/dL) control.

195 individuals (50.4%) returned surveys. Participants were 71% White, 25% Black, 4% Other, 99% male, and had a mean age of 68.1 years. 87% of patients had HbA1c levels <=9%; 42% had HbA1c levels <7%. 72% had BP levels <140/90 mm Hg and 41% had BP levels <130/80 mm Hg. 89% had controlled LDL-C levels. There was no association between self-reported patient-centered care and BP control, LDL-C control or HbA1c <=9%. However, patients with HbA1c <7% were less likely than those who were uncontrolled to view their care as patient-centered (p = 0.036).

While strict glycemic control has proven benefits for most diabetic patients, among patients with multimorbidity, achieving HbA1c levels of <7% was associated with less patient-centered care, likely reflecting the additional treatment burden necessary to meet this threshold.

Accounting for patient-level factors involved in chronic disease management and individualizing care to meet the needs of patients with multimorbidity may promote more patient-centered chronic illness care.

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