Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models.

dc.contributor.author

Lentz, Trevor A

dc.contributor.author

Hellkamp, Anne S

dc.contributor.author

Bhavsar, Nrupen A

dc.contributor.author

Goode, Adam P

dc.contributor.author

Manhapra, Ajay

dc.contributor.author

George, Steven Z

dc.date.accessioned

2021-06-01T18:13:35Z

dc.date.available

2021-06-01T18:13:35Z

dc.date.issued

2021-04

dc.date.updated

2021-06-01T18:13:34Z

dc.description.abstract

Objective

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.

Participants and methods

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.

Results

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%).

Conclusions

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.
dc.identifier

S2542-4548(20)30194-6

dc.identifier.issn

2542-4548

dc.identifier.issn

2542-4548

dc.identifier.uri

https://hdl.handle.net/10161/23310

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

Mayo Clinic proceedings. Innovations, quality & outcomes

dc.relation.isversionof

10.1016/j.mayocpiqo.2020.09.011

dc.subject

APT, Assistance with Pain Treatment

dc.subject

CMS, Centers for Medicare and Medicaid Services

dc.subject

FFS, Medicare Fee-for-Service

dc.subject

KOA, knee osteoarthritis

dc.subject

LCA, latent class analysis

dc.subject

OA, osteoarthritis

dc.subject

SNF, skilled nursing facility

dc.title

Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models.

dc.type

Journal article

duke.contributor.orcid

Lentz, Trevor A|0000-0002-4286-0733

duke.contributor.orcid

Goode, Adam P|0000-0002-0793-3298

duke.contributor.orcid

George, Steven Z|0000-0003-4988-9421

pubs.begin-page

253

pubs.end-page

264

pubs.issue

2

pubs.organisational-group

School of Medicine

pubs.organisational-group

Duke Clinical Research Institute

pubs.organisational-group

Orthopaedics

pubs.organisational-group

Duke

pubs.organisational-group

Institutes and Centers

pubs.organisational-group

Clinical Science Departments

pubs.publication-status

Published

pubs.volume

5

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models.pdf
Size:
414.26 KB
Format:
Adobe Portable Document Format