Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits.
OBJECTIVE
To evaluate the effectiveness of a cluster visit model led by a diabetes nurse educator for delivering outpatient care management to adult patients with poorly controlled diabetes.


METHODS
This study involved a randomized controlled trial among patients of Kaiser Permanente's Pleasanton, CA, center who were aged 16-75 years and had either poor glycemic control (HbA1c > 8.5%) or no HbA1c test performed during the previous year. Intervention subjects received multidisciplinary outpatient diabetes care management delivered by a diabetes nurse educator, a psychologist, a nutritionist, and a pharmacist in cluster visit settings of 10-18 patients/month for 6 months. Outcomes included change (from baseline) in HbA1c levels; self-reported changes in self-care practices, self-efficacy, and satisfaction; and utilization of inpatient and outpatient health care.


RESULTS
After the intervention, HbA1c levels declined by 1.3% in the intervention subjects versus 0.2% in the control subjects (P < 0.0001). Several self-care practices and several measures of self-efficacy improved significantly in the intervention group. Satisfaction with the program was high. Both hospital (P = 0.04) and outpatient (P < 0.01) utilization were significantly lower for intervention subjects after the program.


CONCLUSIONS
A 6-month cluster visit group model of care for adults with diabetes improved glycemic control, self-efficacy, and patient satisfaction and resulted in a reduction in health care utilization after the program.
Sadur
C N
CN
Department of Medicine, Kaiser Permanente Medical Care Program, Northern California, Pleasanton 94588, USA.
Moline
N
N
Costa
M
M
Michalik
D
D
Mendlowitz
D
D
Roller
S
S
Watson
R
R
Swain
B E
BE
Selby
J V
JV
Javorski
W C
WC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000451:nursing / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin