Organizing Diabetes Care: Identify, Monitor, Prioritize, Intensify

The need for radical and rapid improvement in diabetes care was clearly articulated by Williams in 1967 (1), but progress toward that laudable goal has been painfully slow. Only recently have population-based reports from primary care settings documented significant progress toward the goal of better diabetes care (2,3,4,5). In these and other studies (6), multiple interventions that address office systems, provider behavior, and patient behavior were usually needed to improve diabetes care (7,8). Successful interventions often used common strategies to improve care. These strategies included 1) accurately identifying patients with diabetes (9); 2) monitoring one or more important clinical parameters, such as glycosylated hemoglobin (HbA_1c) or cholesterol levels; 3) prioritizing patients based on their clinical status and readiness to change (10); and 4) intensifying care through active outreach or visit planning.

Although identification of diabetic patients can be accomplished in most settings, stratification of patients by risk presents greater challenges. Risk information can be used to prioritize patients and to match interventions to level of risk, which may substantially increase the effectiveness of interventions (11). In this issue, Selby et al. (12) present an …