Study Suggests Veterans with Hypertension and Comorbidities Receive Better Care than Veterans with Hypertension Alone
- Veterans with hypertension and comorbid conditions had greater odds of receiving good quality of care. Moreover, as the number of chronic conditions increased, so did the odds of receiving appropriate overall care for hypertension.
- Veterans with both concordant and discordant types of conditions were almost twice as likely as those without these conditions to receive appropriate quality of care for hypertension.
- Findings did not change after adjusting for age, illness severity, and/or the number of primary care and specialty care visits.
- No relationship was found between the provision of guideline-recommended care for hypertension and patients’ perception of quality of care, nor did patients’ assessment of quality of care vary by the presence of co-existing conditions. Among a subset of 4,432 Veterans in the cohort used to assess perceptions of quality of care, 74.6% reported their quality of care as "excellent" or "very good."
With the widespread adoption of pay-for-performance programs, the effect of common, chronic, co-existing conditions on measures of the quality of healthcare and patient ratings of their care is of concern to healthcare providers. The evidence regarding whether patients with comorbid conditions receive better or worse care is mixed. This study sought to determine the impact of different types of co-existing chronic diseases on quality of care for hypertension, as well as patient perceptions of quality. Investigators analyzed data for Veterans with hypertension who received primary care in 2005 at eight VA facilities in three states, identifying chronic conditions that were concordant and discordant with hypertension treatment goals. Veterans were then classified into four condition groups: 1) hypertension-concordant condition (diabetes, ischemic heart disease, dyslipidemia, n=70,098); 2) hypertension-discordant condition (arthritis, depression, chronic obstructive pulmonary disease, n=12,283), 3) both conditions (n=36,633), and 4) Veterans with no other comorbid conditions (n=22,595).
- Albeit extremely common, this study focused on only one chronic condition (hypertension).
This study was partly funded by HSR&D. Drs. Petersen, Woodard, and Pietz and Ms. Urech are part of HSR&D’s Houston Center for Quality of Care and Utilization Studies.
Petersen L, Woodard L, Henderson L, Urech T, and Pietz K. Will Hypertension Performance Measures Used for Pay-for-Performance Programs Penalize those Who Care for Medically Complex Patients? Circulation 2009 Jun 16;119(23):2978-85.