Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988–2002

Saaddine, Jinan B.; Cadwell, Betsy L.; Gregg, Edward W.; Engelgau, Michael M.; Vinicor, Frank; Imperatore, Giuseppina; Narayan, K.M. Venkat

doi:10.7326/0003-4819-144-7-200604040-00005

Cited by 500 publications

(365 citation statements)

References 37 publications

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“…[53][54][55] Our observed processes of care were also similar to national norms. A recent study conducted by Tuncelli et al evaluating 5-year trends from 1997 to 2001 found that LDL testing improved from 37% to 67%.…”

Section: Discussionsupporting

confidence: 51%

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

et al. 2009

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BACKGROUND:The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied. OBJECTIVE:To assess the effect of OA implementation at 1 year on: (1) diabetes care processes (testing for A1c, LDL, and urine microalbumin), (2) intermediate outcomes of diabetes care (SBP, A1c, and LDL level), and (3) health-care utilization (ED visits, hospitalization, and outpatient visits). METHODS:We used a retrospective cohort study design to compare process and outcomes for 4,060 continuously enrolled adult patients with diabetes from six OA clinics and six control clinics. Using a generalized linear model framework, data were modeled with linear regression for continuous, logistic regression for dichotomous, and Poisson regression for utilization outcomes. RESULTS:Patients in the OA clinics were older, with a higher percentage being African American (51% vs 34%) and on insulin. In multivariate analyses, for A1c testing, the odds ratio for African-American patients in OA clinics was 0.47 (CI: 0.29-0.77), compared to nonAfrican Americans ]. For urine microablumin, the odds ratio for non-African Americans in OA clinics was 0.37 (CI: 0.17-0.81). At 1 year, in adjusted analyses, patients in OA clinics had significantly higher SBP (mean 6.4 mmHg, 95% CI 5.4 -7.5). There were no differences by clinic type in any of the three health-care utilization outcomes.CONCLUSION: OA scheduling was associated with worse processes of care and SBP at 1 year. OA clinic scheduling should be examined more critically in larger systems of care, multiple health-care settings, and/or in a randomized controlled trial.

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Section: Discussionsupporting

confidence: 51%

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

et al. 2009

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“…Patients with other chronic multisystem disorders, e.g., asthma, diabetes mellitus, and congestive heart failure, have benefited from the introduction and implementation of protocols for disease management including definition of quantifiable therapeutic goals [13][14][15][16][17]. For GD1, therapeutic goals believed to be clinically meaningful, but not necessarily equivalent to normal values [18], and monitoring guidelines [11] have been proposed in the context of a disease management algorithm that may be applied to current and future treatments (see Fig.…”

Section: Introductionmentioning

confidence: 99%

A benchmark analysis of the achievement of therapeutic goals for type 1 Gaucher disease patients treated with imiglucerase

Weinreb¹,

Taylor²,

Cox

et al. 2008

American J Hematol

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To assess the extent to which patients with type 1 Gaucher disease (GD1) receiving individualized enzyme replacement therapy with imiglucerase attain six defined therapeutic goals. One hundred and ninety-five GD1 patients enrolled in the ICGG Gaucher Registry, all of whom had data available for hemoglobin, platelet count, liver volume, spleen volume, bone pain, and bone crises at first infusion and after 4 years of therapy with imiglucerase, were evaluated for achievement of published therapeutic goals. The proportion of patients who met all six therapeutic goals increased from 2.1% at first infusion to 41.5% at 4 years; ‡5 goals from 12.8% to 76.9%; ‡4 goals from 37.4% to 92.8%; ‡3 goals from 70.8% to 99.0%; and ‡2 goals from 95.4% to 99.5%. All patients met at least one goal at first infusion and after 4 years of treatment. The proportion of patients meeting specific therapeutic goals increased for all parameters between first infusion and 4 years of therapy: platelet count (24.6%-79.5%), spleen volume (25.6%-78.5%), liver volume (45.6%-90.8%), bone pain (62.6-70.3%), hemoglobin (68.2-91.8%), and bone crises (91.8-99.0%). On average, patients who received higher doses of imiglucerase achieved a greater number of therapeutic goals. This analysis provides a benchmark for evaluating the utility of a disease management approach for GD1 based on monitoring achievement of therapeutic goals after treatment with imiglucerase. Am. J. Hematol. 83:890-895, 2008. V

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“…There has been a reduction in mortality from cardiovascular disease over the past 30 years in most developed countries [4,5] which can be partly attributed to improved management of risk factors over this period [6,7]. Whilst recent studies from the US have shown reductions in incident cardiovascular disease events among adults with diabetes, these reductions have been much smaller than in people without diabetes [8,9].…”

Section: Introductionmentioning

confidence: 99%

Trends in cardiovascular admissions and procedures for people with and without diabetes in England, 1996–2005

et al. 2008

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Aims/hypothesis The aim of this study was to compare 10-year trends in admissions, with and without diabetes recorded, for myocardial infarction, angina, stroke, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG). Methods We used national hospital-activity data in England collected between 1996 and 2005 and compared trends in admissions, after adjusting for age, sex and area-level deprivation. Results Overall, there was a modest fall in the number of admissions for angina and little change in the numbers of admissions for myocardial infarction (MI) and stroke. From 1996From /1997From to 2005From /2006, the numbers of admissions with diabetes recorded rose for each of MI, angina and stroke; the proportion of admissions with type 2 diabetes recorded rose from 7.2% to 13.9% for MI, from 6.7% to 15.3% for angina and from 6.2% to 11.3% for stroke. Over the 10-year period, after adjusting for age, sex and deprivation, the number of admissions for CABG rose about threefold; for PCI, the number of admissions with diabetes recorded rose 15-fold, compared with a fourfold increase in the number of admissions with diabetes not recorded. Conclusions/interpretation We found significant increases in the numbers of admissions with type 2 diabetes recorded for major cardiovascular events and procedures, which has important financial and public-health implications. Better prevention of type 2 diabetes in at-risk patients and aggressive cardiovascular risk-factor management in current patients with diabetes is needed.

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Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988–2002

Abstract: Diabetes processes of care and intermediate outcomes have improved nationally in the past decade. But 2 in 5 persons with diabetes still have poor LDL cholesterol control, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control.

Cited by 500 publications

References 37 publications

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

A benchmark analysis of the achievement of therapeutic goals for type 1 Gaucher disease patients treated with imiglucerase

Trends in cardiovascular admissions and procedures for people with and without diabetes in England, 1996–2005

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