Impact of generalist care managers on patients with diabetes.
OBJECTIVE
To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes.


METHODS
Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network.


METHODS
A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed. Exposure patients had one or more contacts with a care manager; controls were matched on utilization, demographics, testing, and baseline glucose control. Using role-specific information technology to support their efforts, care managers assessed patients' readiness for change, followed guidelines, and educated and motivated patients.


METHODS
Patient data collected as part of an electronic patient record were combined with care manager-created databases to assess timely testing of glycosylated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels and changes in LDL and HbA1c levels.


RESULTS
In a multivariable model, the odds of being overdue for testing for HbA1c decreased by 21 percent in the exposure group (n=1,185) versus the control group (n=4,740). The odds of being tested when overdue for HbA1c or LDL increased by 49 and 26 percent, respectively, and the odds of HbA1c <7.0 percent also increased by 19 percent in the exposure group. The average HbA1c levels decreased more in the exposure group than in the controls. The effect on LDL was not significant.


CONCLUSIONS
Generalist care managers using computer-supported diabetes management helped increase adherence to guidelines for testing and control of HbA1c levels, leading to improved health status of patients with diabetes.
Dorr
David A
DA
Department of Medical Information & Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Wilcox
Adam
A
Donnelly
Steven M
SM
Burns
Laurie
L
Clayton
Paul D
PD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000458:organization & administration* / Q000592:standards; D016022:Case-Control Studies; D002908:Chronic Disease; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006801:Humans; D007061:Idaho; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D009042:Motivation; D010348:Patient Care Team / Q000592:standards*; D010353:Patient Education as Topic; D012189:Retrospective Studies; D014589:Utah
D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL