Last updated Jan. 2006
Note |
A multidisciplinary team brings together the particular
skills and experience of several health professionals
to contriubute to a common purpose. |
|
What
We Want to Achieve Through Systems Changes
Team Care: Advantages
Short-term
cost savings associated with team care can result from shorter length
of hospital stay, reduced rate of hospital readmission, or reductions
in disabilities and associated costs. For example, in one study
the average length of stay for patients with a primary diagnosis
of diabetes was 56% shorter for team-managed patients than for patients
managed by an internist alone and 35% shorter than for patients
seen only by an endocrinologist. The reduction in length of stay
was largest when consultation was obtained early in the hospital
stay.13 Another study showed significant reductions in readmission
rates for team-managed patients.14 An outpatient team can deal with
management issues or potential complications early, before they
develop into serious problems that warrant a costly emergency room
visit or hospital admission.
A
study of patients who maintained an average hemoglobin A1C
value of 7.5% reported improved quality of life on five scales,
including symptom distress, general perceived health, and cognitive
functioning. Compared with the control group, this group also had
higher retained employment, greater productive capacity, and less
absenteeism, resulting in significant short-term cost savings.15
Long-term
benefits
Both
the DCCT16 (Diabetes Control and Complications Trial conducted by
the NIDDK) and the UKPDS17 (United Kindom Prospective Diabetes Study)
improved health outcomes by providing intensive management that
involved team care, frequent patient follow-up care, counseling,
and ongoing patient education. Intensively treated patients achieved
an HbA1c value of 7.2% in the DCCT and 7% in the UKPDS, compared
with 8.9% and 7.9%, respectively, for conventionally treated patients.
Although these trials did not study aspects of the team care they
practiced, it is unlikely that their results could have been achieved
without a team approach.
The
DCCT
found that intensive treatment for patients with type 1 diabetes
reduced the risk for microvascular complications for eye disease
by 76%, kidney disease by 65%, and nerve damage by 64%. A follow-up
study indicated that the reduction in risk for progressive eye and
kidney disease persisted for at least 4 years after the DCCT ended,
despite increasing blood glucose values.
The
UKPDS
showed that intensive treatment maintained over time for patients
with type 2 diabetes reduced the risk for retinopathy by 21%, cataract
extraction by 24%, microvascular endpoints by 25%, and albuminuria
by 33%. Lowering blood pressure in a subset of UKPDS subjects to
a mean of 144/82 mm Hg reduced the risk of strokes, diabetes-related
deaths, heart failure, microvascular complications, and visual loss
up to 56%.
Although
almost every patient can be expected to benefit from any increment
in improved glycemic regulation, blood glucose control is more effective
in preventing the initial development of microvascular complications
than in preventing their progression once they have become established.
Early therapeutic intervention also is more cost-effective. There
is a marked correlation between glycemic control and the cost of
medical care, with medical charges increasing significantly for
every 1% increase in A1C above 7%.18 In fact, the increase in medical
charges accelerates as the A1C value increases. These findings
underscore the need for early diagnosis and treatment of type 2
diabetes.
Resources
Team Care: Comprehensive Lifetime Management
www.ndep.nih.gov/resources/health.htm
This report was developed by the National Diabetes Education Program to help organizational leaders in health care systems, health care providers, and purchasers of health care to implement team care for people with diabetes in all clinical settings.
-Return
to the Top-
-Return Home-
Continue to
Comunity Partnerships |
|