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Patients with hypertension plus additional coexisting conditions more likely to receive higher-quality care
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Patients with hypertension who have other chronic co-existing conditions have higher odds of receiving high-quality care.
Researchers included 141,609 veterans with hypertension in the study and assigned them to one of four groups. Patients classified as hypertension-concordant also had diabetes, ischemic heart disease or dyslipidemia (49.5%; n=70,098); patients who were hypertension-discordant had arthritis, chronic obstructive pulmonary disease or depression (8.7%; n=12,283). The remaining groups of patients had either both hypertension-concordant and hypertension-discordant conditions (25.9%; n=33,633); or they had none (16.0%; n=22,595).
Patients with both hypertensive conditions were more likely to have their BP controlled at index than those with no other comorbid conditions after adjustment for age (OR=1.61; 95% CI, 1.56-1.67). The adjusted odds of receiving appropriate follow-up at six months were higher for patients with both hypertensive conditions (OR=1.64; 95% CI, 1.57-1.73). At index reading, 12,956 patients with no other comorbidities had BP control, as did 45,334 patients with concordant-only conditions, 7,742 with discordant-only conditions and 25,339 with both (P<.001 for comparison). When compared with patients with no additional comorbidities, patients with both types of hypertensive conditions received the highest-quality care (OR=2.25; 95% CI, 2.13-2.38).
“Our results should be reassuring policy makers who have faced criticism that performance measures, public reporting and pay-for-performance initiatives may penalize health care providers of patients with multiple coexisting chronic conditions,” the researchers wrote. “Our findings suggest that performance measurement programs will not necessarily penalize those providers who care for the most medically complex patients.”
Petersen L. Circulation. 2009;119:2978-2985.
This is very reassuring and practitioners should probably feel some
relief that these new pay-for-performance programs will not unnecessarily
penalize them because of the complexity of the patient. That being said, this
study was done entirely within the VA system with a VA population, as well as
with a totally electronic record. Most of the country does not have an
electronic record and most of the country does not have the willing VA
population, so just how that biases these results is not clear to me. There is
no question that increasing complexity for medical patients is going to be much
better handled with the hope of an electronic medical record and its related
tools. Those are the types of patients where we are very limited with our
traditional paper record systems. 
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– Carl J. Pepine, MD
Cardiology Today Chief Medical Editor