title: The association between quality of care and the intensity of diabetes disease management programs.
abstract: BACKGROUND
  Although disease management programs are widely implemented, little is known about their effectiveness.
  
  
  OBJECTIVE
  To determine whether disease management by physician groups is associated with diabetes care processes, control of intermediate outcomes, or the amount of medication used when intermediate outcomes are above target levels.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Patients were randomly sampled from 63 physician groups nested in 7 health plans sponsored by Translating Research into Action for Diabetes (87%) and from 4 health plans with individual physician contracts (13%).
  
  
  METHODS
  8661 adults with diabetes who completed a survey (2000-2001) and had medical record data.
  
  
  METHODS
  Physician group and health plan directors described their organizations' use of physician reminders, performance feedback, and structured care management on a survey; their responses were used to determine measures of intensity of disease management. The current study measured 8 processes of care, including most recent hemoglobin A1c level, systolic blood pressure, serum low-density lipoprotein cholesterol level, and several measures of medication use.
  
  
  RESULTS
  Increased use of any of 3 disease management strategies was significantly associated with higher adjusted rates of retinal screening, nephropathy screening, foot examinations, and measurement of hemoglobin A1c levels. Serum lipid level testing and influenza vaccine administration were associated with greater use of structured care management and performance feedback. Greater use of performance feedback correlated with an increased rate of foot examinations (difference, 5 percentage points [95% CI, 1 to 8 percentage points]), and greater use of physician reminders was associated with an increased rate of nephropathy screening (difference, 15 percentage points [CI, 6 to 23 percentage points]). No strategies were associated with intermediate outcome levels or level of medication management.
  
  
  CONCLUSIONS
  Physician groups were not randomly sampled from population-based listings, and disease management strategies were not randomly allocated across groups.
  
  
  CONCLUSIONS
  Disease management strategies were associated with better processes of diabetes care but not with improved intermediate outcomes or level of medication management. A greater focus on direct measurement, feedback, and reporting of intermediate outcome levels or of level of medication management may enhance the effectiveness of these programs.
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1736, USA. cmangione@mednet.ucla.edu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Robert B
authors.initials: RB
authors.lastname: Gerzoff
authors.forename: David F
authors.initials: DF
authors.lastname: Williamson
authors.forename: W Neil
authors.initials: WN
authors.lastname: Steers
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
authors.forename: Beth E
authors.initials: BE
authors.lastname: Waitzfelder
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.forename: Catherine
authors.initials: C
authors.lastname: Kim
authors.forename: William
authors.initials: W
authors.lastname: Herman
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Thompson
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
mesh_terms: D000368:Aged; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D019468:Disease Management; D005246:Feedback; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000592:standards*; D017010:Reminder Systems
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin