چکیده (انگلیسی):

Background:The vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of
care; however, clinical practice guidelines, interventions, and public reporting metrics do not adequately address
the interaction of these multiple conditions. To advance the understanding of diabetes clinical care in the context
of multiple chronic conditions, we must understand how care overlaps, or doesn’t, between diabetes and its co-occurring
conditions. This study aimed to determine which chronic conditions are concordant (share care goals with diabetes) and
discordant (do not share care goals) with diabetes care, according to primary care provider expert opinion.
Methods:Using the Delphi technique, we administered an iterative, two-round survey to 16 practicing primary care
providers in an academic practice in the Midwestern USA. The expert panel determined which specific diabetes care
goals were also care goals for other chronic conditions (concordant) and which were not (discordant). Our diabetes
care goals were those commonly used in quality reporting, and the conditions were 62 ambulatory-relevant condition
categories.
Results:Sixteen experts participated and all completed both rounds. Consensus was reached on the first round for
94% of the items. After the second round, 12 conditions were concordant with diabetes care and 50 were discordant.
Of the concordant conditions, 6 overlapped in care for 4 of 5 diabetes care goals and 6 overlapped for 3 of 5 diabetes
care goals. Thirty-one discordant conditions did not overlap with any of the diabetes care goals, and 19 overlapped
with only 1 or 2 goals.
Conclusions:This study significantly adds to the number of conditions for which we have information on
concordance and discordance for diabetes care. The results can be used for future studies to assess the impact of
concordant and discordant conditions on diabetes care, and may prove useful in developing multimorbidity guidelines
and interventions.