Comorbidity: implications for the importance of primary care in 'case' management.

Barbara Starfield, Klaus W. Lemke, Terence Bernhardt, Steven S. Foldes, Christopher B. Forrest, Jonathan Weiner

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Although comorbidity is very common in the population, little is known about the types of health service that are used by people with comorbid conditions. METHODS: Data from claims on the nonelderly were classified by diagnosis and extent of comorbidity, using a case-mix measure known as the Johns Hopkins Adjusted Clinical Groups, to study variation in extent of comorbidity and resource utilization. Visits of patients (adults and children) with 11 conditions were classified as to whether they were to primary care physicians or to other specialists, and whether they involved the chosen condition or other conditions. RESULTS: Comorbidity varied within each diagnosis; resource use depended on the degree of comorbidity rather than the diagnosis. When stratified by degree of comorbidity, the number of visits for comorbid conditions exceeded the number of visits for the index condition in almost all comorbidity groups and for visits to both primary care physicians and to specialists. The number of visits to primary care physicians for both the index condition and for comorbid conditions almost invariably exceeded the number of visits to specialists. These patterns differed only for uncommon conditions in which specialists played a greater role in the care of the condition, but not for comorbid conditions. CONCLUSIONS: In view of the high degree of comorbidity, even in a nonelderly population, single-disease management does not appear promising as a strategy to care for patients. In contrast, the burden is on primary care physicians to provide the majority of care, not only for the target condition but for other conditions. Thus, management in the context of ongoing primary care and oriented more toward patients' overall health care needs appears to be a more promising strategy than care oriented to individual diseases. New paradigms of care that acknowledge actual patterns of comorbidities as well as the need for close coordination between generalists and specialists require support.

Original languageEnglish (US)
Pages (from-to)8-14
Number of pages7
JournalAnnals of Family Medicine
Volume1
Issue number1
StatePublished - May 2003

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Case Management
Comorbidity
Primary Health Care
Primary Care Physicians
Diagnosis-Related Groups
Disease Management
Population
Health Services
Patient Care
Delivery of Health Care

ASJC Scopus subject areas

  • Family Practice

Cite this

Starfield, B., Lemke, K. W., Bernhardt, T., Foldes, S. S., Forrest, C. B., & Weiner, J. (2003). Comorbidity: implications for the importance of primary care in 'case' management. Annals of Family Medicine, 1(1), 8-14.

Comorbidity : implications for the importance of primary care in 'case' management. / Starfield, Barbara; Lemke, Klaus W.; Bernhardt, Terence; Foldes, Steven S.; Forrest, Christopher B.; Weiner, Jonathan.

In: Annals of Family Medicine, Vol. 1, No. 1, 05.2003, p. 8-14.

Research output: Contribution to journalArticle

Starfield, B, Lemke, KW, Bernhardt, T, Foldes, SS, Forrest, CB & Weiner, J 2003, 'Comorbidity: implications for the importance of primary care in 'case' management.', Annals of Family Medicine, vol. 1, no. 1, pp. 8-14.
Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner J. Comorbidity: implications for the importance of primary care in 'case' management. Annals of Family Medicine. 2003 May;1(1):8-14.
Starfield, Barbara ; Lemke, Klaus W. ; Bernhardt, Terence ; Foldes, Steven S. ; Forrest, Christopher B. ; Weiner, Jonathan. / Comorbidity : implications for the importance of primary care in 'case' management. In: Annals of Family Medicine. 2003 ; Vol. 1, No. 1. pp. 8-14.
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