title: Primary care diabetes bundle management: 3-year outcomes for microvascular and macrovascular events.
abstract: OBJECTIVE
  To determine whether a system of care with an all-or-none bundled measure for primary-care management of diabetes mellitus reduced the risk of microvascular and macrovascular complications compared with usual care.
  
  
  METHODS
  A parallel pre-post observational design was used. In 2006, a system of care for diabetes was implemented for some members of the Geisinger Health Plan. A total of 4095 primary-care patients were in the Diabetes System of Care group (DS) and compared with a propensity score-matched cohort of 4095 primary care patients not in the system of care (non-Diabetes System of Care [NDS]).
  
  
  METHODS
  Cumulative hazard rate was measured over a 3-year period for retinopathy, amputation, stroke, and myocardial infarction (MI).
  
  
  RESULTS
  The adjusted hazard ratios (HRs) for MI (HR, 0.77; 95% CI, 0.65- 0.90), stroke (HR, 0.79; CI, 0.65-0.97), and retinopathy (HR, 0.81; CI, 0.68-0.97) were all significantly lower among DS patients. The adjusted HR for major amputations (HR, 1.32; CI, 0.45-3.85) did not differ between groups, but only 17 major amputations occurred during the follow-up period. The necessary number of patients to treat in order to prevent 1 event over 3 years was 82 for MI, 178 for stroke, and 151 for retinopathy.
  
  
  CONCLUSIONS
  A system of care with an all-or-none bundled measure used in primary care for patients with diabetes may reduce the risk of MI, stroke, and retinopathy over a 3-year period.
authors.affiliation: 100 N. Academy Ave, Danville, PA 17822-3836. E-mail: fbloom@geisinger.edu.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Bloom
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Yan
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Graf
authors.forename: Tammy
authors.initials: T
authors.lastname: Anderer
authors.forename: Duane E
authors.initials: DE
authors.lastname: Davis
authors.forename: Stevem B
authors.initials: SB
authors.lastname: Pierdon
authors.forename: James
authors.initials: J
authors.lastname: Pitcavage
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Steele
mesh_terms: D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D064872:Patient Care Bundles / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D057216:Propensity Score; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology