Health Care Costs and Financing

A collaborative approach to diabetes care in community health centers can cost-effectively improve that care

The Health Disparities Collaboratives (HDC), begun in 1998 in Federally qualified community health centers (HCs), has focused on improving the quality of diabetes care. It has led to improvements across multiple domains of diabetes care that, together, are substantial. If these improvements are maintained or enhanced over the lifetime of patients, the HCD program will be cost-effective for society, concludes a new study.

The researchers examined data from the Diabetes HDC program in 17 Midwestern HCs in 1998, 2000, and 2002. They abstracted data on diabetes care processes and risk factor levels from medical charts of randomly selected patients. The HDC trains HC staff to use the tools of rapid QI and chronic disease management. HC staff members acquire skills and share best practices at learning sessions and develop programs tailored to their centers.

From 1998 to 2002, multiple process of care (for example, glycosylated hemoglobin (HbA1c) testing rates) increased from 71 to 92 percent and ACE inhibitor prescribing increased from 33 to 55 percent. Levels of diabetes risk factors also improved; for example, HbA1c levels declined by 0.45 percent from a baseline of 8.53 percent.

The authors estimated that these improvements at the HCs studied would reduce the lifetime incidence of diabetes-related complications such as blindness from 17 to 15 percent, end-stage renal disease from 18 to 15 percent, and coronary artery disease from 28 to 24 percent. The average improvement in quality-adjusted life year was 0.35 and the incremental cost-effectiveness ratio was $33,386 per QALY. This ratio is below the traditionally accepted cost-effectiveness thresholds. This study was supported in part by the Agency for Healthcare Research and Quality (HS10479 and HS13635).

See "The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers," by Elbert S. Huang, Qi Zhang, Sydney E.S. Brown, and others, in the December 2007 HSR: Health Services Research 42(6), pp. 2174-2193.

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