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Understanding Variation in Chronic Disease Outcomes

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Abstract

We propose an explanation for variation in disease outcomes based on patient adaptation to the conditions of chronic disease. We develop a model of patient adaptation using the example of Type 2 diabetes mellitus and assumptions about the process entailed in transforming self-care behaviors of compliance with treatment, compliance with glucose monitoring, and patient's knowledge seeking behavior into health outcomes of glycemic control and patient satisfaction. Using data from 609 adults with diagnosed Type 2 diabetes we develop an efficiency (fitness) frontier in order to identify best practice (maximally adapted) patients and forms (archetypes) of patient inefficiency. Outcomes of frontier patients are partitioned by categories of returns to scale. Outcomes for off-frontier patients are associated with disease severity and patient archetype. The model implicates strategies for improved health outcomes based on fitness and self-care behaviors.

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Authors and Affiliations

  1. Department of Information and Decision Science, University of Minnesota, 321 19th Avenue South, Minneapolis, MN, 55455, USA

    Paul E. Johnson

  2. School of Public Health, University of Minnesota, MN, USA

    Peter J. Veazie & Laura Kochevar

  3. HealthPartners Research Foundation, Minneapolis, MN, USA

    Patrick J. O'Connor

  4. Department of Healthcare Management, University of Minnesota, MN, USA

    Sandra J. Potthoff

  5. MarketRx Inc., Bridewater, NJ

    Devesh Verma

  6. Department of Computer Science, University of Minnesota, MN, USA

    Pradyumna Dutta

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  1. Paul E. Johnson
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  2. Peter J. Veazie
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  7. Pradyumna Dutta
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Correspondence to Paul E. Johnson.

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Johnson, P.E., Veazie, P.J., Kochevar, L. et al. Understanding Variation in Chronic Disease Outcomes. Health Care Management Science 5, 175–189 (2002). https://doi.org/10.1023/A:1019740401536

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