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Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically
Laura A Petersen1, Lechauncy D Woodard, Louise M Henderson
1MPH, Health Services Research and Development (152), Houston Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA. laurap@bcm.edu
Circulation
|June 3, 2009
Summary
Patients with multiple chronic conditions, including hypertension, received higher quality care. Patient satisfaction with care did not differ based on the number of coexisting conditions.
Area of Science:
- Health Services Research
- Clinical Quality Measurement
- Chronic Disease Management
Background:
- Concerns exist that performance measures may disadvantage healthcare providers caring for patients with multiple chronic conditions.
- This study investigated the impact of comorbidities on hypertension care quality and patient perceptions.
Purpose of the Study:
- To examine how coexisting conditions affect the quality of hypertension care.
- To assess patient perceptions of care quality in relation to comorbidity burden.
Main Methods:
- A cohort of 141,609 veterans with hypertension was analyzed.
- Patients were categorized based on hypertension-concordant and/or -discordant comorbidities.
- Logistic regression assessed associations between comorbidity type/number and receipt of high-quality hypertension care.
Main Results:
- Patients with concordant, discordant, or both types of comorbidities had higher odds of receiving high-quality hypertension care compared to those without.
- These findings persisted after adjusting for illness severity and healthcare utilization.
- Patient satisfaction ratings were not associated with the presence or number of comorbid conditions.
Conclusions:
- Contrary to concerns, patients with greater medical complexity were more likely to receive high-quality hypertension care.
- Subjective patient ratings of care quality did not vary with comorbidity status.
- Findings suggest that providers caring for complex patients may not be penalized by current quality metrics.
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