Lentz Trevor A, Hellkamp Anne S, Bhavsar Nrupen A, Goode Adam P, Manhapra Ajay, George Steven Z
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
Mayo Clin Proc Innov Qual Outcomes. 2021 Jan 19;5(2):253-264. doi: 10.1016/j.mayocpiqo.2020.09.011. eCollection 2021 Apr.
To establish the frequency of concordant, discordant, and clinically dominant comorbidities among Medicare beneficiaries with knee osteoarthritis (KOA) and to identify common concordant condition subgroups.
We used a 5% representative sample of Medicare claims data to identify beneficiaries who received a diagnosis of KOA between January 1, 2012, and September 30, 2015, and matched control group without an osteoarthritis (OA) diagnosis. Frequency of 34 comorbid conditions was categorized as concordant, discordant, or clinically dominant among those with KOA and a matched sample without OA. Comorbid condition phenotypes were characterized by concordant conditions and derived using latent class analysis among those with KOA.
The study sample included 203,361 beneficiaries with KOA and 203,361 non-OA controls. The largest difference in frequency between the two cohorts was for co-occurring musculoskeletal conditions (23.7% absolute difference), chronic pain syndromes (6.5%), and rheumatic diseases (4.5%), all with a higher frequency among those with knee OA. Phenotypes were identified as low comorbidity (53% of cohort with classification), hypothyroid/osteoporosis (27%), vascular disease (10%), and high medical and psychological comorbidity (10%).
Approximately 47% of Medicare beneficiaries with KOA in this sample had a phenotype characterized by one or more concordant conditions, suggesting that existing clinical pathways that rely on single or dominant providers might be insufficient for a large proportion of older adults with KOA. These findings could guide development of integrated KOA-comorbidity care pathways that are responsive to emerging priorities for personalized, value-based health care.
确定患有膝关节骨关节炎（KOA）的医疗保险受益人中并存疾病的一致、不一致和临床主导情况的频率，并识别常见的一致情况亚组。
我们使用了医疗保险索赔数据的5%代表性样本，以识别在2012年1月1日至2015年9月30日期间被诊断为KOA的受益人，以及未诊断为骨关节炎（OA）的匹配对照组。在患有KOA的人群和无OA的匹配样本中，将34种并存疾病的频率分类为一致、不一致或临床主导。并存疾病表型以一致情况为特征，并在患有KOA的人群中使用潜在类别分析得出。
研究样本包括203,361名患有KOA的受益人以及203,361名非OA对照组。两组之间频率差异最大的是同时出现的肌肉骨骼疾病（绝对差异23.7%）、慢性疼痛综合征（6.5%）和风湿性疾病（4.5%），在膝关节OA患者中这些疾病的频率都更高。表型被确定为低并存疾病（队列中53%有分类）、甲状腺功能减退/骨质疏松（27%）、血管疾病（10%）以及高医疗和心理并存疾病（10%）。
在该样本中，约47%患有KOA的医疗保险受益人具有以一种或多种一致情况为特征的表型，这表明依赖单一或主导医疗服务提供者的现有临床路径可能不足以满足很大一部分患有KOA的老年人的需求。这些发现可为综合KOA并存疾病护理路径的开发提供指导，这些路径应响应个性化、基于价值的医疗保健的新优先事项。
