Reductions in diabetic cardiovascular risk by community primary care providers.
OBJECTIVE
To evaluate a community-based, not-for-profit medical group's effectiveness with diabetic management while using an electronic medical record and financial incentives.


METHODS
Descriptive retrospective study over 2 years with published reference standards.


METHODS
There were 5,316 diabetic patients in the medical group (MG) compared with 5,069 diabetic patients reported in the literature (CT). The main outcome measures included serum hemoglobin A1C (HbA1C), total (TC), low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) cholesterol, and clinic measures of systolic (SBP) and diastolic blood pressure. We determined a mean 10-year composite multivariable cardiovascular risk score based upon these parameters.


RESULTS
The mean MG serum HbA1C (7.10+/-0.02; 8.18+/-0.23%), TC (193.2+/-0.64; 218.3+/-6.09 mg/dl), LDL-C (109.2+/-0.52; 137.8+/-4.24 mg/dl), and SBP (132.8+/-0.25; 141.6+/-2.36 mmHg) were below those for the CT (p<0.001). The MG mean overall coronary heart disease risk of 14.9+/-1.4% over 10 years was below that for the CT group of 22.7+/-2.3%, representing a 34.7+/-4.4% reduction (p<0.0002). The electronic medical record and the use of a financial award may have contributed to these results.


CONCLUSIONS
Improvement of cardiovascular risk variables can be achieved in the primary care setting. Electronic tools and incentives may facilitate this improvement.
Reed
H Lester
HL
MultiCare Medical Group, MultiCare Health System, Tacoma, Washington, USA. lester.reed@middlemore.co.nz
Bernard
Elaine
E
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001291:Attitude of Health Personnel; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016022:Case-Control Studies; D003153:Community Health Services / Q000592:standards* / Q000639:trends; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011322:Primary Prevention / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose; D006442:Glycated Hemoglobin