Diabetes managed care and clinical outcomes: the Harbor City, California Kaiser Permanente diabetes care system

Abstract

Objective: To investigate diabetes clinical outcomes in a large patient population by comparing results of computer-supported team care to those of usual care.

Study design: Patients enrolled in a diabetes care management program were tracked by a computerized system. Their subsequent healthcare outcomes were compared with those of usual-care patients and those of patients who had been discontinued from being managed in this program.

Patients and methods: Screening rates for glycosylated hemoglobin (GHb), urinary protein, serum lipids, and glycemic and blood pressure control were compared between currently managed and usual-care patients. Hospital days and screening rates in a subset of the currently managed group, long-term managed patients, were compared with those of no longer managed patients.

Results: Screening rates for GHb, urinary protein, and serum lipids were higher in currently managed patients than in usual-care patients. Follow-up of initially elevated GHb in currently managed and usual-care patients showed an overall decrease in both groups. Follow-up of initially elevated blood pressure in currently managed patients showed a decrease in both mean systolic and mean diastolic measurements, while follow-up in usual-care patients showed no change in either mean systolic or mean diastolic measurements. Inpatient utilization for the long-term managed patients decreased between 1995 and 1997 and was lower in 1997 for this group than for no longer managed patients. Screening rates for GHb, urinary protein, and serum lipids were higher in the long-term managed patients than in the no longer managed patients.

Conclusions: Computer-supported care management by a dedicated team appears to reduce the number of hospitalizations and improve screening rates and glycemic and blood pressure control.