Facilitating quality improvement in physician management of comorbid chronic disease in an urban minority practice

• Published in: Journal of the National Medical Association Vol. 99; no. 4; pp. 377 - 383
• Main Authors: KAHN, Linda S, FOX, Chester H, OLAWAIYE, Adefunke, SERVOSS, Timothy J, MCLEAN-PLUNKETT, Elizabeth
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ Slack 01.04.2007; Elsevier Limited; National Medical Association
• Subjects: African Americans; Aged; Biological and medical sciences; Chronic Disease - ethnology; Chronic Disease - prevention & control; Comorbidity; Evidence-Based Medicine; Family Practice - standards; Female; General aspects; Guideline Adherence - statistics & numerical data; Health participants; Humans; Male; Medical Audit; Medical sciences; Middle Aged; New York - epidemiology; Pilot Projects; Primary Health Care - standards; Program Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Assurance, Health Care; Urban Health Services - standards; New York; primary healthcare; Urban environment; Health staff; Primary health care; Chronic disease; Physician; Urban area; Improvement; Concomitant disease; Chronic; Multiple comorbid diseases; comorbidity; Minority; Professional practice; Quality; quality improvement; Tropical medicine; Public health; Quality management
• ISSN: 0027-9684; 1943-4693

Increasing numbers of patients with multiple chronic conditions present in the primary care setting and pose a challenge to physicians who must cope with competing demands while adhering to clinical practice guidelines. We tested a chart audit tool to assess how physicians are managing patients with multiple comorbidities in an inner-city family medicine practice serving minority patients. We developed an evidence-based comorbidity chart audit tool that captures the number of diagnosed, coexisting general medical conditions and adherence to key clinical practice guidelines for each condition. A randomized chart audit was undertaken, with one in every five charts selected, yielding a total of 314 patient charts. The majority of patients (59%) had > or = 2 comorbid chronic conditions, and 32% had > or = 3 comorbid chronic conditions. The highest overall adherence to guidelines was for chronic obstructive pulmonary disease (90%) and asthma (80%), followed by congestive heart failure (75%) and coronary artery disease (58%). For all other conditions, overall adherence to guidelines was < or = 50%. The chart review tool identified inconsistencies in adherence to guidelines across multiple diagnosed conditions, suggesting the importance of adopting a patient-centered approach to management as well as prevention.