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Article Title

A Proactive Diabetes Panel Management Approach: Can It Work and How Does It Work in a Health Care Delivery System?

Publication Date

4-30-2015

Keywords

diabetes, care improvement

Abstract

Background/Aims: Guidelines have been established for the care of type 2 diabetes (T2DM) patients. However, ~50% of adult patients receive the recommended care. Factors contributing to the low rate may include shortage of primary care physicians (PCP) and lack of knowledge and compliance at the patient level. To close this care gap, Kaiser Permanente Southern California (KPSC) initiated proactive panel management (PPM). PPM is a standardized and centralized process in which a health care team supports physicians by proactively identifying and evaluating patients with key and actionable care gaps, and providing patient-specific recommendations to help close the gaps. Patients with glycated HbA1c ≥ 9% were eligible. The purpose of this study was to evaluate clinical comparative effectiveness of PPM in achieving HbA1c control (defined as glycated HbA1c < 9%).

Methods: Data for 10,581 adult T2DM patients who had glycated HbA1c ≥ 9% in 2011 (baseline) but had not received PPM in that year were extracted from electronic medical records. Logistic regression was used to evaluate effectiveness of PPM in 2012 (follow-up) on HbA1c control.

Results: Among the 10,581 patients, 6,728 (63.6%) received PPM during 2012. At baseline, receivers were more likely to be 45–64 years of age, female, and had more years of education than nonreceivers. The two groups were similar in race/ethnicity and household income. During follow-up, the PPM group had a greater reduction in HbA1c (mean [standard deviation]: -2.0 [2.2] vs. -1.6 [2.1], P<0.0001) and a higher percentage of patients achieved HbA1c control (63% [4,232 of 6,728] vs. 54% [2,079 of 3,853], P<0.0001) than the non-PPM group. The differences were not explained by social demographics, baseline service utilization and HbA1c. More patients in the PPM group had a PCP visit and used an antidiabetic medication than the non-PPM group during 2012; these two factors explained the majority of the association between PPM and HbA1c control. PPM was most effective for patients with higher educational attainment, no PCP visit or use of any antidiabetic medication at baseline.

Discussion: PPM using patient-level information in electronic medical records and technology within a prepaid health care delivery system can effectively increase diabetic control for high-risk T2DM patients.

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