Improvement in Diabetes Care Using an Integrated Population-Based Approach in a Primary Care Setting

McCulloch, David K.; Price, Martha J.; Hindmarsh, Michael; Wagner, Edward H.

doi:10.1089/109350700415078

Cited by 38 publications

(34 citation statements)

References 4 publications

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“…Although organ damage related to diabetes is well recognized, diabetes also causes functional decline, depression, pain, and lost productivity. [2][3][4][5] The estimated direct and indirect societal and health system costs attributable to diabetes totaled approximately $132 billion in 2002, with costs expected to rise to $156 billion by 2010.…”

mentioning

confidence: 99%

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

Handley¹,

Shumway²,

Schillinger³

2008

The Annals of Family Medicine

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PURPOSE This study evaluated the cost-effectiveness of an automated telephone self-management support with nurse care management (ATSM) intervention for patients with type 2 diabetes, which was tested among patients receiving primary care in publicly funded (safety net) clinics, focusing on non-English speakers. METHODSWe performed cost analyses in the context of a randomized trial among primary care patients comparing the effects of ATSM (n = 112) and usual care (n = 114) on diabetes-related outcomes in 4 San Francisco safety net clinics. ATSM uses interactive phone technology to provide surveillance, patient education, and one-on-one counseling, and was implemented in 3 languages for a 9-month period. Cost utility was examined using quality-adjusted life-years (QALYs) derived from changes in scores on the 12-Item Short Form Health Survey. We also examined cost-effectiveness for costs associated with a 10% increase in the proportion of patients meeting diabetes-specifi c public health goals for increasing exercise, as recommended by Healthy People 2010 and the American Diabetes Association. RESULTSThe annual cost of the ATSM intervention per QALY gained, relative to usual care, was $65,167 for start-up and ongoing implementation costs combined, and $32,333 for ongoing implementation costs alone. In sensitivity analyses, costs per QALY ranged from $29,402 to $72,407. The per-patient cost to achieve a 10% increase in the proportion of intervention patients meeting American Diabetes Association exercise guidelines was estimated to be $558 when all costs were considered and $277 when only ongoing costs were considered.CONCLUSIONS The ATSM intervention for diverse patients with diabetes had a cost utility for functional outcomes similar to that of many other accepted interventions targeted at diabetes prevention and treatment, and achieved public health physical activity objectives at modest costs. Because a considerable proportion of costs were fi xed, cost-utility and cost-effectiveness estimates would likely be substantially improved in a scaled-up ATSM program. INTRODUCTIONI n the United States, costs associated with chronic illness care account for nearly 75% of medical expenditures.1 Type 2 diabetes, which affects more than 20 million individuals in this country alone, is associated with substantial morbidity and cost. Although organ damage related to diabetes is well recognized, diabetes also causes functional decline, depression, pain, and lost productivity.2-5 The estimated direct and indirect societal and health system costs attributable to diabetes totaled approximately $132 billion in 2002, with costs expected to rise to $156 billion by 2010. [6][7][8] In recent reviews of the cost-effectiveness of interventions for prevent- COS T-EF F EC T IV ENES S O F AT S M F OR DIA BE T E Sing or treating diabetes in developed countries, the majority of studies focus either on screening for diabetes or on treatment to avert complications, emphasizing medication-sensitive outcomes with long-term benefi ts....

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mentioning

confidence: 99%

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

Handley¹,

Shumway²,

Schillinger³

2008

The Annals of Family Medicine

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“…Absolute change in HbA1c and even a percentage reduction are harder to achieve for patients with lower baseline levels and do not have the same clinical significance as for patients with high levels. Therefore, patients were stratified into four groups based on HbA1c at enrollment: in control (,7), borderline (7)(8), moderate (8.1-10), and severe (.10). These strata were analyzed individually.…”

Section: Methodsmentioning

confidence: 99%

A Decentralized, Patient-Centered Approach to Diabetes Disease Management in the Primary Care Setting

Toscani¹,

O’Connor

Nash

2001

Disease Management

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“…Monthly telephone conferences led by national program faculty focused on these reports. Based on earlier experiences with Chronic Care Collaboratives in non-academic settings 6,7 , the national program leadership crafted a recruitment strategy that was designed to identify highly motivated institutions 2,3,12 . The national initiative offered no financial support, but it offered the opportunity to participate with the national faculty in the national interinstitutional program that facilitated change and learning.…”

Section: Residency Practices and Their Patientsmentioning

confidence: 99%

“…The Chronic Care Model (CCM), an evidence-based strategy for the care of patients with chronic illness [5][6][7][8] , has been implemented in hundreds of community clinical settings, generally with associated improvement of chronic illness care 8 .…”

Section: Introductionmentioning

confidence: 99%

A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

et al. 2010

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BACKGROUND: There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE: To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN: US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives-either a national Collaborative, or a subsequent California Collaborative-to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures-HbA1c <7%, LDL <100 mg/dL, and blood pressure ≤130/80-and three process measures-retinal and foot examinations, and patient self-management goals-were tracked. PARTICIPANTS: Fifty-seven teams from 37 self-selected teaching hospitals committed to implement the CCM in resident continuity practices; 41 teams focusing on diabetes improvement participated over the entire duration of one of the Collaboratives. INTERVENTIONS: Teaching-practice teams-faculty, residents and staff-participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly. RESULTS: Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives. CONCLUSIONS: These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable.

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Improvement in Diabetes Care Using an Integrated Population-Based Approach in a Primary Care Setting

Cited by 38 publications

References 4 publications

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes

A Decentralized, Patient-Centered Approach to Diabetes Disease Management in the Primary Care Setting

A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

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