Chronic Disease

Specific primary care office systems and quality improvement strategies may substantially affect the cost of diabetes care

Some primary care office system and improvement strategies substantially increase future health care costs for people with diabetes, while others significantly decrease them, according to a new study. For example, the use of databases to monitor patient laboratory test results was associated with $2,439 higher costs over a 3-year period. Yet clinics with regular clinician meetings to discuss patient care problems and clinics that used diabetes registries to prioritize patients based on cardiovascular risk were associated with $3,962 and $2,916 lower 3-year costs, respectively.

Physician meetings can contribute to anticipating and sometimes avoiding hospitalization, especially when a moderately ill patient sees a series of providers in a single episode of illness. Such meetings may also provide a forum for physician-nurse communication that benefits care, explains Patrick J. O'Connor, M.D., M.P.H., of HealthPartners Research Foundation.

Researchers also found that quality improvement strategies, which focused on resource use related to diabetes care or heart disease care, were associated with $2,883 and $3,228 lower costs, respectively. However, quality improvement strategies that emphasized pharmacy use for patients with heart disease or depression resulted in $3,059 and $2,962 higher short-term costs, respectively. The findings were based on a prospective study of 1,628 adults who received care for diabetes in 84 clinics within 18 medical groups of a large health care organization. The researchers examined medical claims for these patients over a 3-year period, Medicare records, and surveys of patients, clinic medical directors, and managers. The study was supported by the Agency for Healthcare Research and Quality (HS09946).

See "Impact of office systems and improvement strategies on costs of care for adults with diabetes," by Todd P. Gilmer, Ph.D., Dr. O'Connor, William A. Rush, Ph.D., and others, in the June 2006 Diabetes Care 29(6), pp. 1242-1248.

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