The gap between current medical knowledge and its application in chronic disease management is especially apparent in diabetes care. Although research over the last decade has shown that adherence to standards of care can prevent or delay the onset of devastating diabetic complications, little more than one-third of patients achieve adequate glycaemic control. Obstacles to better care include `system' factors such as inadequate record-keeping and reimbursement policies that reimburse amply for illness but poorly for diabetes education and interventions via telephone and computer. Disparities in healthcare compound the difficulty among vulnerable populations in urban and rural areas. Emerging healthcare delivery systems that encourage payers, providers and consumers to improve diabetes care with the use of information technology and financial incentives are described in different health management settings.
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References
1.
Institute of Medicine.Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001 .
2.
Holman H.Chronic disease — the need for a new clinical education. JAMA2004; 292: 1057—9.
3.
Wagner EH, Austin BT, Davis C., Hindmarsh M., Schaeafer J., Bonomi A.Improving chronic illness care: translating evidence into action. Health Aff2001; 20: 64—78.
4.
Bodenheimer T., Wagner EH, Grumbach K.Improving primary care for patients with chronic illness. JAMA2002; 288: 1775—9.
5.
Casalino L., Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA2003; 289: 434—41.
6.
Li Rui, Simon J., Bodenheimer T., et al. Organizational factors affecting the adoption of diabetes care management processes in physician organizations. Diabetes Care2004; 27: 2312—16.
7.
Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk van JT, Assendelft WJJ. Interventions to improve the management of diabetes in primary care, outpatient, and community settings. A systematic review. Diabetes Care2001; 24: 1821—33.
8.
Narayan Kmv, Boyle JP, Thompson TJ, Sorensen SW, Williamson DFLifetime risk for diabetes mellitus in the United States. JAMA2003; 290: 1884—90.
9.
Centers for Disease Control and Prevention.National Diabetes Fact Sheet, United States, 2003. Available at: http://cdc.gov/diabetes/pubs/factsheet.htm (accessed March 2005).
10.
Hogan P., Dall T., Mikolov P., American Diabetes Association.Economic costs of diabetes in the US in 2002. Diabetes Care2003; 26: 917—32.
11.
The Diabetes Control and Complications Trial (DCCT) Research Group.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med1993; 329: 977—86.
12.
UK Prospective Diabetes Study (UKPDS) Group.Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet1998; 352: 837—53.
13.
Saydah SH, Fradkin J., Cowie CCPoor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA2004; 291: 335—42.
14.
Ford ES, Giles WH, Mokdad A.Increasing prevalence of metabolic syndrome among US adults. Diabetes Care2004; 27: 2444—9.
15.
Agency for Healthcare Research and Quality.2004 National Healthcare Quality Report. AHRQ Publication No. 05-0013. Rockville, MD: Agency for Healthcare Research and Quality, 2004. Available at: http://www.qualitytools.ahrq.gov/qualityreport/download_report.aspx (accessed March 2005).
16.
Garber AJ, Seidel J., Armbruster M.Current standards of care for inpatient glycemic management and metabolic control: is it time for definite standards and targets? Endocr Pract2004; 10(Suppl. 2): 10—12.
17.
Agency for Healthcare Research and Quality.Economic and health cost of diabetes: HCUP Highlight 1 . AHRQ Publication No. 05-0034. Rockville, MD: Agency for Healthcare Research and Quality, 2005. Available at: http://www.ahrq.gov/data/hcup/highlight1/high1.htm (accessed March 2005).
18.
Gilmer TP, O'Connor PJ, Manning WG, Rush WAThe cost to health plans of poor glycemic control. Diabetes Care1997; 20: 1847—53.
19.
Grant GW, Pirraglia PA, Meigs JB, Singer DETrends in complexity of diabetes care in the United States from 1991 to 2000 . Arch Intern Med2004; 164: 1134—9.
20.
Beck JK, Logan KJ, Hamm RM, et al. Reimbursement for pediatric diabetes intensive case management: a model for chronic disease?Pediatrics2004 ; 113: e47—50.
21.
Wagner EH, Austin BT, Von Korff M.Organizing care for patients with chronic illness. Milbank Q1996; 74: 511—44.
22.
Kirkman S., Williams SR, Caffrey HH, Marrero DGImpact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care2002; 25: 1946—51.
23.
US Department of Health and Human Services.Healthy people 2010. Washington, DC : US Government Printing Office, 2000.
24.
Balas EA, Krishna S., Kretschmer RA, et al. Computerized knowledge management in diabetes care. Med Care2004; 42: 610—21.
25.
Siminerio L., Zgibor J., Solano FXImplementing the chronic care model for improvements in diabetes practice and outcomes in primary care: the University of Pittsburgh Medical Center experience. Clin Diabetes2004; 22: 54—8.
26.
Nobel JJ, Norman NKEmerging information management technologies and the future of disease management . Dis Manag2003; 6: 219—31.
27.
Starren J., Hripcsak G., Sengupta S., et al. Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: technical implementation. J Am Med Inform Assoc2002; 9: 25—36.
28.
Freudenheim M.Digital Rx: take two aspirins and e-mail me in the morning. New York Times, 2 March 2005 .
29.
Greenes RA, Shortliffe EHMedical informatics: an emerging academic discipline and institutional priority . JAMA1990; 263: 1114—20.
30.
Shea S., Starren J., Weinstock RS, et al. Columbia University's Informatics for Diabetic Education and Telemedicine (IDEATel) Project: rationale and design. J Am Med Inform Assoc2002; 9: 49—62.
31.
Centers for Medicare and Medicaid Services.Medicare physician group practice demonstration. 2005. Available at: www.cms.hhs.gov/researchers/demos/PGP.asp (accessed March 2005).
32.
Lohr S.Health care industry seeks a role model. New York Times, 31 October 2004.
33.
Sawin CT, Walder DJ, Bross DS, Pogach LMDiabetes process and outcomes measures in the Department of Veterans Affairs . Diabetes Care2004; 27: B90—4.
34.
Hayward RA, Hofer TP, Kerr EA, Krein SLQuality improvement initiatives: issues in moving from diabetes guidelines to policy. Diabetes Care2004; 27(Suppl. 2): B54—60.
35.
Perlin JB, Kolodner RM, Roswell RHThe Veteran's Health Administration: quality, value, accountability and information as transforming strategies for patient-centered care. Am J Manag Care2004; 10: 828—36.
36.
Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med2004; 141: 938—45.
37.
Epstein AM, Lee TH, Hamel MBPaying physicians for high-quality care. N Engl J Med2004; 350: 406—10.
38.
Rosenthal MB , Fernandopulle R., Song HR, Landon B.Paying for quality: providers' incentives for quality improvement. Health Aff2004; 23: 127—41.
39.
Integrated Healthcare Associated.California's pay for performance program for doctors announces first year results: estimate $50 million bonus payout. 2004. Available at: www.iha.org (Accessed March 2005).
40.
Bridges to Excellence. Available at: http://www.bridgestoexcellence.org (accessed April 2005).
41.
Levetan CS, Dawn KR, Robbins DC, Ratner REImpact of computer-generated personalized goals on HbA1c. Diabetes Care2002; 25: 2—8.
42.
Miall J.Diabetes in the workplace: a case study. CAI eMagazine, 11 February 2004. www.imakenews.com/seroper/e_article0002226854.cfm?x=b11,0.w.
43.
Kaufman DR, Patel VL, Hilliman C., et al. Usability in the real world: assessing medical information technologies in patients' homes. J BiomedInform2003; 36: 45—60.
44.
Roland M.Linking physician's pay to the quality of care — a major experiment in the United Kingdom. N Engl J Med2004; 351: 1448—54.
45.
Urac.URAC study: medical management organizations respond to `Crossing the Quality Chasm'. 2005. Available at: www.urac.org (accessed March 2005).
