Patients with chronic disease often have comorbid illness that presents challenges to achieve optimal control. Here, the relationship between clinical complexity and the quality of care that patients with diabetes receive for glycemic, blood pressure, and lipid control is examined.

Patients from seven Veterans Affairs facilities in three states were included in the study. Patients were classified as having 0, 1, 2, or ≥3 comorbid conditions. Those with three or more comorbidities had a higher level of illness burden and were defined as having greater clinical complexity. A total of 35,872 patients were measured at index and at 90 days. All patients had a primary care visit between July 2007 and June 2008. The quality of diabetes care was assessed using the American Diabetes Association recommended level for blood pressure, glycated hemoglobin and low-density lipoprotein cholesterol.

Key Findings:

• Patients with greater clinical complexity were more likely to receive higher quality care across all 3 indicators.

Several limitations to this study should be noted. The population studied was primarily male, and Veterans Affairs facilities have been shown to have a higher prevalence of diabetes and comorbidities than the general population.

While health care providers may provide the most aggressive management to their most ill patients, these findings highlight the relationship that clinical complexity has on treating chronic illness.