Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost

Abstract

BackgroundAn estimated 30.3 million Americans have diabetes mellitus. The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality of life for people who either have or are at risk for diabetes mellitus, and hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative.ObjectiveThe aim of this study was to evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to diabetes mellitus, health care utilization, and cost.MethodsA propensity score matched two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment were used for outcome variables. The intervention cohort included diabetes mellitus patients who were recruited to a diabetes self-management program. Control cohort subjects were identified from the HealthCore Integrated Research Environment by at least two diabetes-associated claims (International Classification of Diseases-Ninth Revision, ICD-9 250.xx) within 2 years before the program launch date (October 1, 2011-September 30, 2013) but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and postintervention all-cause and diabetes-related utilization and costs. Cost outcomes are reported as least squares means. Repeated measures analyses (generalized estimating equation approach) were conducted for utilization, comorbid conditions, and costs.ResultsThe program participants who were identified in HealthCore Integrated Research Environment claims (N=558) were matched to a control cohort of 1669 patients. Following the intervention, the self-management cohort experienced significant reductions for diabetes mellitus–associated comorbid conditions, with the postintervention disease burden being significantly lower (mean 1.6 [SD 1.6]) compared with the control cohort (mean 2.1 [SD 1.7]; P=.001). Postintervention all-cause utilization was decreased in the intervention cohort compared with controls with −40/1000 emergency department visits vs +70/1000; P=.004 and −5780 outpatient visits per 1000 vs −290/1000; P=.001. Unadjusted total all-cause medical cost was decreased by US $2207 in the intervention cohort compared with a US $338 decrease in the controls; P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was –US $815 (P=.049).ConclusionsPatients in the BCBH-D program experienced reduced all-cause health care utilization and costs. Direct cost savings were US $815. Although encouraging, given the complexity of the patient population, further study is needed to cross-validate the results.

Assessment of Rwandan diabetic patients’ needs and expectations to develop their first diabetes self-management smartphone application (Kir’App)

“…Recent evidence from a pre–postparallel group design study indicates that self-management reduces diabetes mellitus (DM)-associated comorbid conditions as well as healthcare utilization and, therefore, overall cost. 7 According to a meta-analysis of eight studies, DSM improved DM-related quality of life. 8 Mezuk and colleagues found significant improvements of glycated haemoglobin (HbA1c) through self-management in a group setting in which lay healthcare workers served as coaches.…”

Perspektien digitaler Diabetesprävention: wo wollen wir hin?

“…Neueste Befunde aus den USA zeigen, dass DSME durchaus Erfolge vorzuweisen hat: So reduziert ein erfolgreiches Selbstmanagement unter anderem das Auftreten diabetesassoziierter Komorbiditäten und die Inanspruchnahme ärztlicher Dienstleistungen. Die Kostenreduktion für das Gesundheitssystem ist evident [20]. Eine Senkung des HbA 1c -Wertes wird durch das Selbstmanagement ermöglicht, jedoch nach bisherigem Kenntnisstand nur unter der Beteiligung eines Gesundheitsdienstleisters [17,18,21].…”

Developing a Clinical Practice Guideline for Surgical Diabetic Patients

“…Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and a lengthy hospital stay. Poor preoperative glycemic control portends poor intraoperative glycemic control, which is an established risk factor for perioperative morbidity (Turner et al, 2018). Surgical patients with perioperative hyperglycemia have a higher risk for infection and associated adverse consequences after surgery compared to patients without hyperglycemia.…”