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    Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list

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    Authors
    Bayliss, Elizabeth A.
    Bayliss, Martha S.
    Ware, John E. Jr.
    Steiner, John F.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2004-09-09
    Keywords
    Activities of Daily Living
    Adult
    Aged
    Boston
    Chicago
    Chronic Disease
    *Comorbidity
    Fee-for-Service Plans
    Female
    Health Maintenance Organizations
    Humans
    Hypertension
    Longitudinal Studies
    Los Angeles
    Male
    Medicine
    Middle Aged
    Outcome Assessment (Health Care)
    Primary Health Care
    Psychometrics
    Quality of Life
    Regression Analysis
    *Sickness Impact Profile
    Specialization
    Biostatistics
    Epidemiology
    Health Services Research
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    Abstract
    BACKGROUND: Primary care physicians are caring for increasing numbers of persons with comorbid chronic illness. Longitudinal information on health outcomes associated with specific chronic conditions may be particularly relevant in caring for these populations. Our objective was to assess the effect of certain comorbid conditions on physical well being over time in a population of persons with chronic medical conditions; and to compare these effects to that of hypertension alone. METHODS: We conducted a secondary analysis of 4-year longitudinal data from the Medical Outcomes Study. A heterogeneous population of 1574 patients with either hypertension alone (referent) or one or more of the following conditions: diabetes, coronary artery disease, congestive heart failure, respiratory illness, musculoskeletal conditions and/or depression were recruited from primary and specialty (endocrinology, cardiology or mental health) practices within HMO and fee-for-service settings in three U.S. cities. We measured categorical change (worse vs. same/better) in the SF-36(R) Health Survey physical component summary score (PCS) over 4 years. We used logistic regression analysis to determine significant differences in longitudinal change in PCS between patients with hypertension alone and those with other comorbid conditions and linear regression analysis to assess the contribution of the explanatory variables. RESULTS: Specific diagnoses of CHF, diabetes and/or chronic respiratory disease; or 4 or more chronic conditions, were predictive of a clinically significant decline in PCS. CONCLUSIONS: Clinical recognition of these specific chronic conditions or 4 or more of a list of chronic conditions may provide an opportunity for proactive clinical decision making to maximize physical functioning in these populations.
    Source
    Health Qual Life Outcomes. 2004 Sep 7;2:47. Link to article on publisher's site
    DOI
    10.1186/1477-7525-2-47
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47458
    PubMed ID
    15353000
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1186/1477-7525-2-47
    Scopus Count
    Collections
    Population and Quantitative Health Sciences Publications

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