No abstract

Disease management for chronic conditions is a call for collaboration among all parties of the health care system. The Caritas Christi Health Care System established a unified American Diabetes Association (ADA) recognized outpatient diabetes self-management education program (DSME) in each of its six hospital communities and has established an Internet data portal with managed care organizations to improve preventive care for thousands of patients with diabetes. This article describes the stepwise process of building the successful Caritas Diabetes Care Program and the central role of the Caritas Diabetes Registry over a 5-year period.

An algorithm for the care of type 2 diabetes as used by the Partners Healthcare System is presented. Included recommendations are consistent with and rely heavily on published and generally accepted standards of care, including a recent published consensus statement and the 2009 American Diabetes Association Clinical Practice Guidelines. Areas of focus include criteria for diagnosis, recommended treatment targets and frequency of care components, management recommendations for the care of hyperglycemia, lipids, and of hypertension. Additional teaching is provided in the form of frequently asked questions answered by domain experts.

Little is known about the numbers of disabled people employed in industry except for those registered with the Department of Employment and Productivity. A joint survey by six factory doctors covering 11,399 men aged 16 to 64 in seven companies is described. 1,233 men (10.8 per cent of the population) were identified as having chronic medical impairments which could affect working capacity. The prevalence rose from 3 per cent under the age of 25 to 28 per cent over the age of 60. Only one third of these men were officially registered and they were not representative of all the disabled either in terms of severity or of diagnosis. The commonest causes of disablement were chronic bronchitis and asthma, disorders of the spine, coronary heart disease and severe visual loss.