Diabetes is the seventh leading cause of death in the United States and diabetes? improving glycemic control in people with diabetes. …
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Case Management Interventions are Strongly Recommended to Improve Glycemic Control in Diabetes
Diabetes is the seventh leading cause of death in the United States and accounted for 98 billion in total US healthcare system costs in 1997 Over 15 million Americans have diabetes, including 54 million who dont know they have the disease Diabetes management is complex and difficult for both the patient and the healthcare provider, and traditional healthcare delivery methods have not adequately met their needs Because better glycemic blood sugar control increases the quality of life of people with diabetes and results in cost savings for healthcare organizations, an important question is: what health-systems level interventions are effective in improving glycemic control in people with diabetes? A systematic review of published studies, conducted on behalf of the Task Force on Community Preventive Services by a team of experts, including those from the Centers for Disease Control and Prevention CDC, the National Institute of Diabetes and Digestive and Kidney Disorders NIDDK, found that case management interventions
are effective in improving glycemic control in people with diabetes Based on this review, Task Force recommends that these strategies be implemented on the basis of strong evidence of effectiveness Background on the Intervention Case management involves improved planning, coordination, and provision of care to address the needs of a population at risk for excessive resource use, poor outcomes, or poor coordination of services Case management usually assigns authority to a professional case manager who does not provide direct health care but oversees and is responsible for coordinating and implementing care Case management has 5 essential features: 1 identification of eligible patients, 2 assessment, 3 development of an individual care plan, 4 implementation of care plan, and 5 monitoring of outcomes Case management can be delivered as a single intervention or as part of a multicomponent intervention eg, disease management Findings from the Systematic Review In 14 of the 15 studies that met inclusion criteria for review, case management improved glycemic control Case management improved glycemic control median glycated hemoglobin [GHb] by 05 percentage points when implemented
with disease management and by 04 percentage points without it An improvement of this size is associated with a decrease in diabetes-related complications and death When delivered as part of disease management, case management improved the frequency of monitoring of GHb levels by healthcare providers median 33 increase in monitoring Case management was effective in adults with type 2 diabetes in managed care systems; applying the findings beyond these populations and settings has not been well defined Future research should: 1 define what interventions may be added to case management to optimize health outcomes, 2 identify the optimal intensity of patient contact and who should deliver the intervention, and 3 determine the effect of case management on other outcomes, such as patient behaviors, lipid levels, blood pressure, cost, and quality of life Publications: MMWR/Recommendations and Reports September 28, 2001/Vol 50/RR-16 : A report on findings American Journal of Preventive Medicine - Am J Prev Med 2002: 22 4S; 15-38: A report on evidence and findings See wwwthecommunityguideorg/diabetes/ for individual articles
The Guide to Community Preventive Services Community Guide
provides recommendations on population-based interventions to promote health and to prevent disease, injury, disability, and premature death, appropriate for use by communities and healthcare systems For more information about the Community Guide including links to publications and a variety of resources see wwwthecommunityguideorg for Diabetes see wwwthecommunityguideorg/diabetes/ This information is public domain Copying and disseminating freely is encouraged However, citation to source is appreciated
Updated December 27, 2002
Source:changingdiabetes-us.com
