A Systematic Approach to Risk Stratification and Intervention Within a Managed Care Environment Improves Diabetes Outcomes and Patient Satisfaction
- Charles M. Clark, Jr., MD1,
- James W. Snyder, MD2,
- Robert L. Meek, MS3,
- Linda M. Stutz, RN, MBA4 and
- Christopher G. Parkin, MS5
- 1Indiana University, Indianapolis, Indiana;
- 2VA Southern Nevada Healthcare System, Las Vegas, Nevada;
- 3Roche Diagnostics Corporation;
- 4Meszzia Corporation;
- 5CGParkin Communications, Indianapolis, Indiana.
Abstract
OBJECTIVE—To determine whether a comprehensive diabetes management program that included risk stratification and social marketing would improve clinical outcomes and patient satisfaction within a managed care organization (MCO).
RESEARCH DESIGN AND METHODS—The 12-month prospective trial was conducted at primary care clinics within a MCO and involved 370 adults with diabetes. Measurements included 1) the frequency of dilated eye and foot examinations, microalbuminuria assessment, blood pressure measurement, lipid profile, and HbA1c measurement; 2) changes in blood pressure, lipid levels, and HbA1c levels; and 3) changes in patient satisfaction.
RESULTS—Complete data are reported for the 193 patients who had been enrolled for 12 months; life table analysis is reported for all patients who remained enrolled at the study’s end as well as for a comparative control group of 623 patients. For the 193 patients for whom 12-month data were available, the number of patients in the low-risk category (HbA1c <7%) increased by 51.1%. A total of 97.4% of patients with an HbA1c >8% at baseline had a change in treatment regimen. Patients at the highest risk for coronary heart disease (LDL >130 mg/dl) decreased from 25.4% at baseline to 20.2%. Patients with a blood pressure <130/85 mmHg increased from 23.8 to 44.6%. Of these patients, 63.0% had changes in medication. Patients and providers expressed significant increases in satisfaction with the program.
CONCLUSIONS—The program was successful in initiating the recommended changes in the diabetic therapeutic regimen, resulting in improved glycemic control, increased monitoring/management of diabetic complications, and greater patient and provider satisfaction. These results should have great significance in the design of future programs in MCOs aimed at improving the care of people with diabetes and other chronic diseases.
- ADA, American Diabetes Association
- DQIP, Diabetes Quality Improvement Project
- HEDIS, Health Plan Employer Data and Information Set
- HMO, health maintenance organization
- MAU, microalbumin
- MCO, managed care organization
- PAID, Problem Areas In Diabetes
- SMBG, self-monitoring of blood glucose.
Footnotes
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Address correspondence and reprint requests to Charles M. Clark, Jr. MD, Regenstrief Institute, 1050 Wishard Boulevard, Indianapolis, IN 46202. E-mail: Chclark{at}iupui.edu.
Received for publication 29 June 2000 and accepted in revised form 23 February 2001.
J.W.S. served on the advisory panel of Sierra Health Services, which helped conduct the study and received grant funding. L.M.S. was employed by Roche Diagnostics during the implementation of this study.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
