Bayliss et al studied how chronic medical conditions impact a decline in a patient’s physical function. The authors are from the University of Colorado Health Sciences Center, Kaiser Permanente Denver and Quality Metric Inc in Lincoln, Rhode Island.


Patient selection: adults in primary care with or without hypertension in the Medical Outcome Study (MOS), apparently without known cancer


Outcome: absolute decline of >= 6.5 points in the physical component summary (PCS) score in the SF-36 Health Survey over 4 years.


Factors that may contribute to physical decline:

(1) congestive heart failure (CHF)

(2) diabetes mellitus

(3) chronic respiratory disease (asthma, COPD, other)

(4) 4 or more chronic medical conditions


Chronic medical conditions included:

(1) diabetes mellitus (listed above)

(2) congestive heart failure (listed above)

(3) respiratory disease (listed above)

(4) coronary artery disease (angina, AMI, other)

(5) musculoskeletal disease (back pain, hip impairment, osteoarthritis, rheumatoid arthritis, etc)

(6) depression

(7) possibly hypertension



• It is impossible to get to 4 or more chronic medical conditions without having at least 1 of the first 3 listed factors.

• Peripheral vascular and cerebrovascular disease would take their toll as well.


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