By the same authors

From the same journal

Impact of the Prevalence of Concordant and Discordant Conditions on the Quality of Diabetes Care in Family Practices in England

Research output: Contribution to journalArticlepeer-review

Published copy (DOI)


  • Ignacio Ricci-Cabello
  • Sarah Stevens
  • Evangelos Kontopantelis
  • Andrew R H Dalton
  • Robert I Griffiths
  • John L Campbell
  • Timothy Doran
  • Jose M. Valderas


Publication details

JournalAnnals of Family Medicine
DatePublished - Nov 2015
Issue number6
Number of pages9
Pages (from-to)514-22
Original languageEnglish


PURPOSE: The purpose of this study was to examine the association between the prevalence of both diabetes-concordant and diabetes-discordant conditions and the quality of diabetes care at the family practice level in England. We hypothesized that the prevalence of concordant (or discordant) conditions would be associated with better (or worse) quality of diabetes care.

METHODS: We conducted a cross-sectional study using practice-level data (7,884 practices). We estimated the practice-level prevalence of diabetes and 15 other chronic conditions, which were classified as diabetes concordant (ie, with the same pathophysiologic risk profile and therefore more likely to be part of the same management plan) or diabetes discordant (ie, not directly related in either their pathogenesis or management). We measured quality of diabetes care with diabetes-specific indicators (8 processes and 3 intermediate outcomes of care). We used linear regression models to quantify the effect of the prevalence of the conditions on aggregate achievement rate for quality of diabetes care.

RESULTS: Consistent with the proposed model, the prevalence rates of 4 of 7 concordant conditions (obesity, chronic kidney disease, atrial fibrillation, heart failure) were positively associated with quality of diabetes care. Similarly, negative associations were observed as predicted for 2 of the 8 discordant conditions (epilepsy, mental health). Observations for other concordant and discordant conditions did not match predictions in the hypothesized model.

CONCLUSIONS: The quality of diabetes care provided in English family practices is associated with the prevalence of other major chronic conditions at the practice level. The nature and direction of the observed associations cannot be fully explained by the concordant-discordant model.

    Research areas

  • Adolescent, Adult, Aged, Aged, 80 and over, Chronic Disease, Comorbidity, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, England, Family Practice, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Prevalence, Quality of Health Care, Young Adult, Journal Article

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