Aims To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patientreported outcomes. Methods We conducted a structured systematic review of outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus-driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals. Results The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient-reported outcome measures: the WHO Well-Being Index for psychological well-being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case-mix adjustment. Conclusions We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient-reported outcomes enables people living with diabetes to report directly on their condition in a structured way.
Objectives: Healthcare delivery in Singapore is currently fragmented with over-emphasis on expensive episodic hospital care. Most family physicians can be better equipped to deliver chronic disease management (CDM). The distribution of CDM between family physicians in the public and private sectors is disproportionate. We believe that the Patient-Centered Medical Home (PCMH) model of care which emphasizes integrated care will a) lead to improved patient outcomes, reduced cost and greater efficiency; b) increase the engagement of private family physicians for CDM. Methodology: In this paper, we describe the implementation and initial experience of the Frontier Family Medicine Clinic (a public-private partnership to pilot the PCMH model) and its potential to address the care gaps in our healthcare system. The PCMH model involves population management of 1000 patients, including 100 high-risk patients for complex case management. Results: Implementation required intensive engagement of multiple stakeholders, including educating both family physicians and hospital leadership on the value of this approach. With
A767 49-89% of the total annual costs associated with schizophrenia. ConClusions: Schizophrenia imposes a substantial economic burden on society mainly driven by high indirect costs. The cost estimates varied due to methodology differences and costs included. The information of disease burden associated with schizophrenia is crucial to enable informed decision-making in allocating health care resources.
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