Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2007 Feb;22(2):215-22.
doi: 10.1007/s11606-006-0072-5.

Can a chronic care model collaborative reduce heart disease risk in patients with diabetes?

Roberto B Vargas  1 , Carol M Mangione, Steven Asch, Joan Keesey, Mayde Rosen, Matthias Schonlau, Emmett B Keeler
Affiliations
Comparative Study

Can a chronic care model collaborative reduce heart disease risk in patients with diabetes?

Roberto B Vargas et al. J Gen Intern Med. 2007 Feb.

Abstract

Background: There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes.

Objective: We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes.

Design: Controlled pre- and postintervention study.

Patients/participants: Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites.

Measurements and main results: Ten-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI -3.7%, -0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention.

Conclusions: Over a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization's settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Chronic illness care collaborative intervention. Adapted from Cretin et al. 2004.
Figure 2
Figure 2
Patient selection.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/archinte.158.6.617', 'is_inner': False, 'url': 'https://doi.org/10.1001/archinte.158.6.617'}, {'type': 'PubMed', 'value': '9521226', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9521226/'}]}
    2. Sowers JR. Diabetes mellitus and cardiovascular disease in women. Arch Intern Med. 1998;158:617–21. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '12744542', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12744542/'}]}
    2. Tedesco JV, Wright RS, Williams BA, et al. Effect of diabetes on the mortality risk of cardiogenic shock in a community-based population. Mayo Clin Proc. 2003;78(5):561–6. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJM199807233390404', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejm199807233390404'}, {'type': 'PubMed', 'value': '9673301', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9673301/'}]}
    2. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229–34. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/s11892-002-0093-3', 'is_inner': False, 'url': 'https://doi.org/10.1007/s11892-002-0093-3'}, {'type': 'PubMed', 'value': '12643183', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12643183/'}]}
    2. Winer N, Sowers JR. Cardiovascular risk factors in diabetic patients with hypertension. Curr Diab Rep. 2002;2(3):263–6. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/archinte.164.13.1422', 'is_inner': False, 'url': 'https://doi.org/10.1001/archinte.164.13.1422'}, {'type': 'PubMed', 'value': '15249351', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15249351/'}]}
    2. Almdal T, Scharling H, Jensen J, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med. 2004;164(13):1422–6. - PubMed