Redesign of a Diabetes System of Care Using an All-or-None Diabetes Bundle to Build Teamwork and Improve Intermediate Outcomes

Bloom, Frederick J.; Graf, Thomas; Anderer, Tammy; Stewart, Walter F.

doi:10.2337/diaspect.23.3.165

Cited by 20 publications

(25 citation statements)

References 14 publications

(12 reference statements)

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“…41 GHS also has a diabetes system of care for persons with diabetes that includes expectations that providers will measure HbA1c every 6 months and maintain HbA1c < 7.0%, in addition to monitoring and setting targets for other measures, such as cholesterol, blood pressure, urine protein, vaccinations, and smoking status. 42,43 While weight management is not a targeted measure, providers participating in this system of care are probably also counseling patients about the importance of weight control in T2DM. This system of care was well established at the time of the study, and diabetes care was not likely to differ by drug class and thus not likely to bias the effect of drug selection on weight loss.…”

Section: Limitationsmentioning

confidence: 99%

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

McAdam‐Marx¹,

Bellows²,

Unni³

et al. 2014

JMCP

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BACKGROUND: Managed care organizations put great effort into managing the population of patients with type 2 diabetes mellitus (T2DM) because of the health and economic burden of this disease. In patients with T2DM, weight loss and glycemic control are primary treatment aims to help improve patient outcomes, but these goals are not easily achieved. While achieving these aims requires a multifaceted approach of drug therapy management and lifestyle modification, truly understanding the role of medication adherence in achieving these outcomes is important for both patient and population management. This study expands on existing evidence that weight loss is associated with improved glycemic control by examining the role of medication adherence in achieving these goals in a managed care setting. This study is unique in that these associations are evaluated using multiple sources of data, including medical records for treatment outcomes, pharmacy claims, and patient-reported data to assess medication adherence. These data sources represent those typically available to payers or providers.OBJECTIVE: To describe the relationships between medication and adherence, weight change, and glycemic control in patients with T2DM.METHODS: This historical cohort study included adult patients with T2DM in a large integrated health system and was based on electronic health record and pharmacy claims data from November 1, 2010, through October 31, 2011, as well as data from a self-reported adherence survey conducted in March 2012. Included patients received a diabetes medication from a therapeutic class not previously received, between November 1, 2010, and April 30, 2011 (index date), who had blood glucose (HbA1c) and weight values at index date and 6 months follow-up, participated in an adherence survey, and had ≥ 1 prescription claim for the index-date drug. Associations between the dual outcomes of weight loss (≥ 3%) and HbA1c control (< 7.0%), while controlling for medication adherence and other demographic, treatment, and clinical variables, were evaluated using structural equation models (SEM). Separate models adjusted for different measures of medication adherence-self-reported using the 5-item Medication Adherence Rating Scale (MARS-5) and a modified medication possession ratio (mMPR) from pharmacy claims data. RESULTS:The study included 166 patients with a mean age of 61.1 (standard deviation = 12.1) years; 56.0% were female. Medication adherence was high, with 72.2% adherent using MARS-5 and 77.1% using mMPR measures. The SEMs found that only self-reported medication adherence is associated with weight loss (MARS-5: OR = 1.70, 95% CI = 1.11-2.60), while both self-reported and claims-based medication adherence were associated with HbA1c < 7.0% (MARS-5: OR = 1.59, 95% CI = 1.09-2.34; mMPR: OR 2.71, 95% CI = 1.22-5.98). Further, weight loss is significantly associated with HbA1c < 7.0% (MARS-5: OR = 3.60, 95% CI = 2.39-5.46; mMPR: OR 2.99, 95% CI = 1.45-6.17).CONCLUSIONS: This study has provided additional evidence ...

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Section: Limitationsmentioning

confidence: 99%

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

McAdam‐Marx¹,

Bellows²,

Unni³

et al. 2014

JMCP

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“…The care is directed by a physician and delivered by a team that doi: 10.1377/hlthaff.2014.0428 includes the patient and family as active team members focused on process and outcome measures of evidence-based diabetes care. 11 In Germany the dominant models used to improve care for people with chronic conditions are disease management programs. The programs for six disease areas were established in 2002 and rolled out nationally in various years: in 2002 for diabetes mellitus type 2 and breast cancer, in 2003 for coronary artery disease, in 2004 for diabetes mellitus type 1, and in 2005 for asthma and chronic obstructive pulmonary disease.…”

mentioning

confidence: 99%

Chronic Care Model Strategies In The United States And Germany Deliver Patient-Centered, High-Quality Diabetes Care

et al. 2014

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Improving the quality of care for chronic diseases is an important issue for most health care systems in industrialized nations. One widely adopted approach is the Chronic Care Model (CCM), which was first developed in the late 1990s. In this article we present the results from two large surveys in the United States and Germany that report patients' experiences in different models of patient-centered diabetes care, compared to the experiences of patients who received routine diabetes care in the same systems. The study populations were enrolled in either Geisinger Health System in Pennsylvania or Barmer, a German sickness fund that provides medical insurance nationwide. Our findings suggest that patients with type 2 diabetes who were enrolled in the care models that exhibited key features of the CCM were more likely to receive care that was patient-centered, high quality, and collaborative, compared to patients who received routine care. This study demonstrates that quality improvement can be realized through the application of the Chronic Care Model, regardless of the setting or distinct characteristics of the program.

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“…The bundled care process has been utilized within the Geisinger System for various diseases since 2005, including for diabetes, congestive heart failure, hypertension, and osteoporosis. Initiation of a diabetes bundle within the system has improved the percentage of patients achieving all nine of its measures from 2.4% at its inception to 13.1% 4 years later (16). On the basis of the success that we observed in a nephrology department-specific bundle for CKD implemented in 2006, a system-wide CKD bundle was initiated in 2009.…”

Section: Managing the Ckd Populationmentioning

confidence: 93%

“…Rates of 2.4%-12.8% of patients achieving all seven measures for a diabetes bundle have been reported from major health systems after implementation of the all-or-none bundle, providing evidence of how difficult it is to achieve multiple recommendations in individual patients (14,15). Patient preferences, polypharmacy, medication costs, coverage issues, and appropriate individualization of bundled targets for specific patients by providers are all cited reasons why a higher total percentage achieved, than those referenced above, has not been obtained (16). The bundled care process has been utilized within the Geisinger System for various diseases since 2005, including for diabetes, congestive heart failure, hypertension, and osteoporosis.…”

Section: Managing the Ckd Populationmentioning

confidence: 99%

Nephrology Care in a Fully Integrated Care Model

Norfolk

Hartle

2013

Clinical Journal of the American Society of Nephrology

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Redesign of a Diabetes System of Care Using an All-or-None Diabetes Bundle to Build Teamwork and Improve Intermediate Outcomes

Cited by 20 publications

References 14 publications

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

Chronic Care Model Strategies In The United States And Germany Deliver Patient-Centered, High-Quality Diabetes Care

Nephrology Care in a Fully Integrated Care Model

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