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

Abstract

The care for people with diabetes and most chronic illness suffers if it is acute, reactive, and fragmentary. We report the first 5 years of a comprehensive, integrated approach to diabetes care at Group Health Cooperative of Puget Sound, a large group model Health Maintenance Organization in Washington State. The program is population-based, evidence-based, and patient-centered. Primary care teams receive support in the form of electronic diabetes registries, evidence-based guidelines, patient self-management support, and decentralized onsite consultation with a diabetes expert team (a physician and nurse specialist). In a population of more than 15,000 patients with diabetes, by 1998 more than 70% had had a dilated retinal examination and microalbuminuria test in the previous 12 months, 82% had received a foot examination, and 68% of patients have a hemoglobin A_1c (Hb A_1c) under 8.0%. Patient satisfaction improved while costs and utilization decreased. Overall costs decreased by $62 per member per month, despite a slight increase in pharmacy costs. In conclusion we have shown that an integrated and proactive approach to diabetes care improves health outcomes and patient satisfaction and decreases overall costs of care.