skip to page content
Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Go to the ORD website
Go to the QUERI website

HSR&D Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Impact of clinical complexity on the quality of diabetes care.

Woodard LD, Landrum CR, Urech TH, Wang D, Virani SS, Petersen LA. Impact of clinical complexity on the quality of diabetes care. The American journal of managed care. 2012 Sep 1; 18(9):508-14.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
   Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions


OBJECTIVES: To assess the impact of clinical complexity on 3 dimensions of diabetes care. STUDY DESIGN: We identified 35,872 diabetic patients receiving care at 7 Veterans Affairs facilities between July 2007 and June 2008 using administrative and clinical data. We examined control at index and appropriate care (among uncontrolled patients) within 90 days, for blood pressure ( < 130/80 mm Hg), glycated hemoglobin ( < 7%), and low-density lipoprotein cholesterol ( < 100 mg/dL). We used ordered logistic regression to examine the impact of complexity, defined by comorbidities count and illness burden, on control at index and a combined measure of quality (control at index or appropriate follow-up care) for all 3 measures. RESULTS: There were 6260 (17.5%) patients controlled at index for all 3 quality indicators. Patients with > 3 comorbidities (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.67-2.26) and illness burden > 2.00 (OR, 1.22; 95% CI, 1.13-1.32) were more likely than the least complex patients to be controlled for all 3 measures. Patients with > 3 comorbidities (OR, 2.30; 95% CI, 2.07-2.54) and illness burden > 2.00 (OR, 1.25; 95% CI, 1.18-1.33) were also more likely than the least complex patients to meet the combined quality indicator for all 3 measures. CONCLUSIONS: Patients with greatest complexity received higher quality diabetes care compared with less complex patients, regardless of the definition of complexity chosen. Although providers may appropriately target complex patients for aggressive control, deficits in guideline achievement among all diabetic patients highlight the challenges of caring for chronically ill patients and the importance of structuring primary care to promote higher-quality, patient-centered care.

Questions about the HSR&D website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.