title: A systematic approach to risk stratification and intervention within a managed care environment improves diabetes outcomes and patient satisfaction.
abstract: OBJECTIVE
  To determine whether a comprehensive diabetes management program that included risk stratification and social marketing would improve clinical outcomes and patient satisfaction within a managed care organization (MCO).
  
  
  METHODS
  The 12-month prospective trial was conducted at primary care clinics within a MCO and involved 370 adults with diabetes. Measurements included 1) the frequency of dilated eye and foot examinations, microalbuminuria assessment, blood pressure measurement, lipid profile, and HbA(1c) measurement; 2) changes in blood pressure, lipid levels, and HbA(1c) levels; and 3) changes in patient satisfaction.
  
  
  RESULTS
  Complete data are reported for the 193 patients who had been enrolled for 12 months; life table analysis is reported for all patients who remained enrolled at the study's end as well as for a comparative control group of 623 patients. For the 193 patients for whom 12-month data were available, the number of patients in the low-risk category (HbA(1c) <7%) increased by 51.1%. A total of 97.4% of patients with an HbA(1c) >8% at baseline had a change in treatment regimen. Patients at the highest risk for coronary heart disease (LDL >130 mg/dl) decreased from 25.4% at baseline to 20.2%. Patients with a blood pressure <130/85 mmHg increased from 23.8 to 44.6%. Of these patients, 63.0% had changes in medication. Patients and providers expressed significant increases in satisfaction with the program.
  
  
  CONCLUSIONS
  The program was successful in initiating the recommended changes in the diabetic therapeutic regimen, resulting in improved glycemic control, increased monitoring/management of diabetic complications, and greater patient and provider satisfaction. These results should have great significance in the design of future programs in MCOs aimed at improving the care of people with diabetes and other chronic diseases.
authors.affiliation: Indiana University, Regenstrief Institute, 1050 Wishard Boulevard, Indianapolis, IN 46202, USA. Chclark@iupui.edu
authors.forename: C M
authors.initials: CM
authors.lastname: Clark
authors.forename: J W
authors.initials: JW
authors.lastname: Snyder
authors.forename: R L
authors.initials: RL
authors.lastname: Meek
authors.forename: L M
authors.initials: LM
authors.lastname: Stutz
authors.forename: C G
authors.initials: CG
authors.lastname: Parkin
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria; D001794:Blood Pressure; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D017719:Diabetic Foot / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000517:prevention & control; D005006:Ethnicity; D005528:Foot; D006442:Glycated Hemoglobin / Q000032:analysis; D006279:Health Maintenance Organizations; D006801:Humans; D007182:Income; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D017060:Patient Satisfaction; D010808:Physical Examination; D044469:Racial Groups; D018570:Risk Assessment; D014481:United States
chemical_list: D006442:Glycated Hemoglobin; D008055:Lipids