Care Management Processes Important for High-Quality Diabetes Care

• DOI: 10.2337/dc22-2372
• Publication Date: 2023-05-31T19:10:46Z
• Authors: Kevin A. Peterson; Caroline S. Carlin; Leif I. Solberg; James Normington; Eric F. Lock
• Keywords: Guideline; Chronic care; Diabetes management

OBJECTIVE Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes care management processes (CMP) primary practices over 3 years. RESEARCH DESIGN AND METHODS This repeated cross-sectional study tracked for all patients seen a cohort of 330 2017 2019. Unit analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic individual CMPs between years by practice. We used Bayesian method to simultaneously estimate five-outcome model: A1c, systolic diastolic blood pressure, guideline-based statin use, Optimal Diabetes Care (ODC). control unobserved time-invariant practice characteristics secular change. modeled correlation errors across outcomes. Statistical significance identified using 99% credible intervals (analogous P < 0.01). RESULTS Implementation 18 62 associated statistically significant improvements patient Together, these resulted 12.1% more meeting ODC measures. Different affected different Three accounted 47% total improvement, 68% A1c decrease, 21% SBP reduction, 55% use increase: 1) systems identifying reminding due testing, 2) after-visit follow-up nonclinician, 3) clinician reminders preventive services during clinic visit. CONCLUSIONS Effective quality focuses redesign that clearly improves Tailoring adoption provides effective through focused