The implementation of managed care for diabetes using medical informatics in a large Preferred Provider Organization.
BACKGROUND
It has been demonstrated by meta analysis that if a regular review of patients is guaranteed, the standard of primary care can be as good or better than hospital outpatient care, however, empirical data suggests that compliance with diabetes clinical practice recommendations is inadequate in primary care. This study describes the reorganization of diabetes care using disease management principles in a Preferred Provider Organization (PPO) operating on a country-wide basis in which each diabetes clinic became responsible for the overall care of all patients with diabetes.


METHODS
This descriptive pre and post change study was undertaken in a large public-funded PPO insuring over one and half million individuals. The study was possible due the use of a centralized electronic disease registry which enabled the collection of all patient data. Several markers, such as HbA1C and LDC-cholesterol levels, were used to assess the quality of care for the diabetic patients.


RESULTS
Mean HbA1C results of the cohort showed a continuous reduction from 8.1% (S.D. = 1.55) in 1999 to 7.68% (S.D. = 1.47) in 2002 and to 7.79 (S.D. = 1.54) in 2004. Improved results were also recorded for LDL-C 126.37 (S.D. = 35.16) in 1999 to 114.74 (S.D. = 34.49) in 2002, and to 113.39 (S.D. = 33.8) in 2004. The number of diabetic patients seen by the diabetologist increased by 62% over this period, despite an increase in diabetologist work hours of only 23%.


CONCLUSIONS
The reorganization of health delivery for diabetic patients within a country-wide PPO, based on the principles of disease management and supported by medical informatics improves quality of care.
Heymann
Anthony D
AD
Maccabi Health Services, 27 Hamered St., Tel Aviv, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel. Heymann_t@mac.org.il
Chodick
Gabriel
G
Halkin
Hillel
H
Karasik
Avraham
A
Shalev
Varda
V
Shemer
Joshua
J
Kokia
Ehud
E
D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007557:Israel; D008490:Medical Informatics; D011243:Preferred Provider Organizations / Q000458:organization & administration / Q000592:standards; D012017:Referral and Consultation; D012042:Registries; D012984:Software
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin