title: Diabetes outcomes within integrated healthcare management programs.
abstract: OBJECTIVE
  The aim of this observational study was to assess mortality of patients with type 2 diabetes by type of healthcare delivery system, i.e. through specialist centers or generalist doctors, or integrated care.
  
  
  METHODS
  The study was conducted at the "Vicentino Ovest" Local Health District in the Veneto Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with diabetes (≥ 20 years old) were identified using different public health databases. They were grouped as: patients followed up by specialists at diabetes clinics (DS); patients seen only by their own general practitioner (GP); and patients receiving integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard ratios for available potential predictors of death by level of care.
  
  
  RESULTS
  The crude mortality rate was highest in the GP group (26.1 per 1000 person-years), the difference being minimal when compared with the DS group (21.7 per 1000 person-years) and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the DS-GP group.
  
  
  CONCLUSIONS
  The findings of the present study could demonstrate that it is safe and cost-effective, after a first specialist assessment at a diabetes service, for low-risk diabetic patients to be managed by family physicians as part of a coordinated care approach, based on the specialist's clinical recommendations; GPs can subsequently refer patients to a specialist whenever warranted by their clinical condition.
authors.affiliation: Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy. Electronic address: vincenzo.baldo@unipd.it.
authors.forename: V
authors.initials: V
authors.lastname: Baldo
authors.affiliation: Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Lombardi
authors.affiliation: Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cocchio
authors.affiliation: Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rancan
authors.affiliation: Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Buja
authors.affiliation: Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cozza
authors.affiliation: Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Marangon
authors.affiliation: Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Furlan
authors.affiliation: Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cristofoletti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D058006:General Practice; D006302:Health Services Research; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010348:Patient Care Team; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012307:Risk Factors; D013038:Specialization; D016896:Treatment Outcome; D055815:Young Adult
keywords: Diabetes; Health care research; Integrated care