title: Impact of office systems and improvement strategies on costs of care for adults with diabetes.
abstract: OBJECTIVE
  To assess the impact of organizational features and improvement strategies of primary care clinics on health care costs of adults with diabetes.
  
  
  METHODS
  This study included a prospective cohort study of 1,628 adults with diabetes in a large, health care organization receiving care in 84 clinics within 18 medical groups. Data from surveys of patients, clinic medical directors and managers, and medical record reviews were merged with 3 years of medical claims. Costs were estimated using health plan data on resource use and common Medicare payment methodologies. Generalized linear regression models were used to analyze costs related to clinic characteristics, adjusting for individual patient comorbidity, demographic, and socioeconomic factors.
  
  
  RESULTS
  Clinics with regular clinician meetings to discuss patient care problems and clinics that used diabetes registries to prioritize patients based on cardiovascular risk were associated with lower 3-year costs: -$3,962 (P = 0.002) and -$2,916 (P = 0.019), respectively. The use of databases to monitor lab results was associated with higher costs ($2,439, P = 0.038). Quality improvement strategies focused on resource use related to diabetes care (-$2,883, P = 0.017) or heart disease care (-$3,228, P = 0.014) were associated with lowered costs, whereas quality improvement strategies that emphasized pharmacy use for patients with heart disease ($3,059, P = 0.029) or depression ($2,962, P = 0.038) were associated with increased costs.
  
  
  CONCLUSIONS
  Several organizational features of primary care offices were significant predictors of future health care costs for adults with diabetes. The mechanism by which such factors affect costs of care and the relationship of costs to clinical outcomes merits further evaluation.
authors.affiliation: Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0622, USA. tgilmer@ucsd.edu
authors.forename: Todd P
authors.initials: TP
authors.lastname: Gilmer
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: William A
authors.initials: WA
authors.lastname: Rush
authors.forename: A Lauren
authors.initials: AL
authors.lastname: Crain
authors.forename: Robin R
authors.initials: RR
authors.lastname: Whitebird
authors.forename: Anne M
authors.initials: AM
authors.lastname: Hanson
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000191:economics*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000145:classification; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D012959:Socioeconomic Factors
chemical_list: D006442:Glycated Hemoglobin