Patients with Multiple Chronic Conditions Do Not Receive Lower Quality of Preventive Care

Original Article



The implications of measuring and rewarding performance for patients with multiple chronic conditions have not been explored empirically.


To examine whether the number of chronic conditions was associated with patient’s receipt of recommended preventive care.


We evaluated the association between the likelihood of receiving recommended preventive care and the number of chronic conditions in the diabetic population by analyzing the 2003 Medical Expenditure Panel Survey using logistic regression. Demographic characteristics and the number of chronic conditions were compared using χ2 tests.


Hemoglobin A1C test and diabetic eye exam.


In 2003, approximately 14.2 million non-institutionalized Americans had diabetes and 23% of them had five or more chronic conditions besides diabetes. Those patients were 67% (p < 0.05) and 50% (p < 0.001) more likely to receive hemoglobin A1C test and eye exams compared with diabetic patients with no additional chronic conditions. After adjusting for the number of office-based physician visits, a larger number of chronic conditions did not significantly affect the likelihood of receiving recommended care. Diabetic patients with more chronic conditions had more frequent office-based physician visits (p < 0.0001), and patients with 11 or more annual office-based physician visits were 43% (p < 0.05) and 40% (p < 0.01) more likely to receive hemoglobin A1C test and eye exam, respectively, compared with diabetic patients who had less than two office-based physician visits.


Diabetic patients with more chronic conditions may receive better quality of preventive care, partly due to their higher number of office-based physician visits.


quality of care chronic conditions performance measures 



This study was financially supported by Harvard School of Public Health institutional funding. Authors are grateful to Dr. Wenke Hwang for sharing the classification system. Helpful comments from Dr. David Kashikara of Agency of Health Care Research and Quality, and Dr. Chapin White of Congressional Budget Office are also greatly appreciated.

Conflicts of interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  2. 2.Health Insurance Review & Assessment ServiceSeoulKorea

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