Labor characteristics and program costs of a successful diabetes disease management program.
BACKGROUND
Organizations have invested in disease management programs to improve quality and to reduce costs, but little is known about the labor characteristics and the program costs necessary to implement a program.


OBJECTIVE
To examine the labor characteristics and the program costs of a successful diabetes disease management program.


METHODS
We performed a labor and cost analysis within a randomized controlled trial of a primary care-based diabetes disease management intervention.


METHODS
Participants included 217 patients with type 2 diabetes mellitus and poor glycemic control (glycosylated hemoglobin levels, > or = 8.0%). The intervention group received 12 months of intensive management from clinical pharmacists and a diabetes care coordinator who provided education, applied algorithms for medication management, and addressed barriers to care. The control group attended a single session led by pharmacists, followed by usual care from their primary providers. The process outcomes included the number of patient care-related activities, time spent per patient, and number of drug titrations or additions. The program costs were calculated based on Bureau of Labor Statistics wage data using a sensitivity analysis.


RESULTS
The disease management team performed a mean of 4.0 care-related activities for a mean of 38.6 minutes per patient per month for intervention patients and performed a mean of 1.1 care-related activities for a mean of 10.7 minutes per patient per month for control patients (P < .001). Intervention patients had a median of 7 drug titrations or additions during the study. The incremental program cost for the intervention was 36.97 dollars (sensitivity analysis, 6.22 dollars-88.56 dollars) per patient per month.


CONCLUSIONS
A successful diabetes disease management program can be integrated into an academic clinic for modest labor and cost.
Rothman
Russell L
RL
Division of General Internal Medicine and Public Health, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Suite 6000, Medical Center East, Nashville, TN 37232-8300, USA. russell.rothman@vanderbilt.edu
So
Stephanie A
SA
Shin
John
J
Malone
Robert M
RM
Bryant
Betsy
B
Dewalt
Darren A
DA
Pignone
Michael P
MP
Dittus
Robert S
RS