title: Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.
abstract: This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved.
authors.affiliation: Florida International University, Miami, FL, USA tpage@fiu.edu.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Page
authors.affiliation: Health Choice Network of Florida, Miami, FL, USA.
authors.forename: St Anthony
authors.initials: SA
authors.lastname: Amofah
authors.affiliation: Health Choice Network of Florida, Miami, FL, USA.
authors.forename: Shelia
authors.initials: S
authors.lastname: McCann
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Rivo
authors.affiliation: General Electric Foundation, Fairfield, CT, USA.
authors.forename: Asha
authors.initials: A
authors.lastname: Varghese
authors.affiliation: Health Choice Network of Florida, Miami, FL, USA.
authors.forename: Terisa
authors.initials: T
authors.lastname: James
authors.affiliation: Health Choice Network of Florida, Miami, FL, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Rivo
authors.affiliation: Florida International University, Miami, FL, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003151:Community Health Centers; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D005431:Florida; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000379:methods*; D010349:Patient Compliance / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D015397:Program Evaluation; D011787:Quality of Health Care; D012042:Registries; D013689:Telephone; D055815:Young Adult
keywords: chronic disease; community intervention; diabetes; health promotion; outcome evaluation; program planning and evaluation