Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care.
BACKGROUND
Safety net urban hospitals are being overwhelmed by an increasing number of patients with diabetes, who frequently only access the health system through visits to emergency departments and urgent care clinics. It is uncertain whether the chronic care model advocated for diabetes care would be feasible and effective for managing diabetes in an acute care setting.


OBJECTIVE
Determine if redesigning the system of care for treating diabetic patients who do not have primary care doctors is feasible, acceptable to patients and effectively lowers patients' haemoglobin A1c, blood pressure and cholesterol levels.


METHODS
Prospective single cohort study.


METHODS
A total of 1098 consecutive diabetic patients presenting to an urgent care clinic at an urban safety net public hospital in Chicago between October 2004 and April 2006 who had a haemoglobin A1c measured at baseline.


METHODS
Adapt the chronic care model for managing diabetes to the acute care setting of an urgent care clinic to manage uninsured patients with diabetes who do not have primary care.


RESULTS
Among the 1098 patients, 833 (76%) had a repeat A1c during the 2- to 12-month follow-up period. On average, A1c values decreased by 1.5 percentage points; systolic blood pressure decreased by 9 mmHg; low-density lipoprotein cholesterol decreased 11 points; and weight decreased 2.3 pounds (all: P < 0.001). The percentage using angiotensin-converting enzyme inhibitor drugs increased from 45% to 83%; aspirin use increased from 38% to 83%; and statin use increased from 34% to 76%.


CONCLUSIONS
This novel chronic care model for diabetes care of uninsured patients without primary care doctors was feasible, acceptable and effective in increasing the quality of diabetes care and decreasing haemoglobin A1c, blood pressure, cholesterol and weight.
Khan
Mohammad A
MA
Department of Medicine, Cook County (Stroger) Hospital, Chicago, IL, USA.
Evans
Arthur T
AT
Shah
Sejal
S
D000328:Adult; D002641:Chicago; D002908:Chronic Disease; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000178:diet therapy* / Q000188:drug therapy*; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008962:Models, Theoretical; D015397:Program Evaluation; D011446:Prospective Studies