TY - JOUR
T1 - Population Management of Diabetes in a High-Need Urban Community in the Bronx
T2 - The Experience of Montefiore Medical Center
AU - Farrell, Patricia
AU - Barnaby, Sandra
AU - Galarza, Tahnee
AU - Simonson, Julie K.
AU - Zonszein, Joel
AU - Meara, Anne
AU - Chung, Henry
AU - Figueira, Rhonda
AU - Felleman, Sheila
N1 - Funding Information:
The DDMP is carried out by a large integrated multidisciplinary team including 7 registered nurses (6 of whom are Certified Diabetes Educators [CDEs] and master’s prepared), 6 coordinators, 2 pharmacists, behavioral health specialists, and a community and social service liaison. The DDMP was created by the CMO and works in close collaboration with the Montefiore Clinical Diabetes Center (Montefiore-CDC) and the Albert Einstein College of Medicine Diabetes Research and Training Center (DRTC). The Montefiore-CDC is a comprehensive educational program that since its creation and certification by the American Diabetes Association (ADA) in 1996 has been addressing the ABCs (A1c, blood pressure, and cholesterol) for individuals with type 2. The Montefiore-CDC program has a Diabetes Self-Management Program (DSMP), called Proactive Managed Information System for Education in Diabetes (PROMISED), which is a 10-hour education workshop during which a registered nurse practitioner and a registered nutritionist (both CDEs) provide a comprehensive interactive program for patients with type 2 diabetes. As part of the collaboration between the DDMP and the Montefiore-CDC, newly diagnosed or low-risk patients are identified by the DDMP program and referred to the Montefiore-CDC to receive education through its PROMISED program. In addition, the CDEs from the DDMP attend weekly teaching rounds at the Montefiore-CDC, which provides a forum for the discussion of cutting-edge recommendations for diabetes management. The DDMP and the Montefiore-CDC both benefit by collaborating with the Albert Einstein College of Medicine DRTC as the faculty overlaps between the medical school and the clinical body at Montefiore Medical Center. The DRTC has been continually funded by the National Institutes of Health since 1977 and has served as a major site for many basic and clinical research advancements in the areas of diabetes, obesity, and metabolic diseases. This unique collaboration provides support for novel and strong strategies in the care of patients with diabetes with translational research targeted to the prevention and treatment of diabetes and its complications, especially in minority and underserved populations. Program effectiveness was evaluated through an interventional, nonrandomized study examining the impact of the DDMP on the high-risk/intensive disease management group. The study included patients older than 18 years with type 2 diabetes who were enrolled in the high-risk DDMP between January 1, 2009, and December 31, 2009. The date of DDMP enrollment served as the patient’s index date. The mean time from baseline to outcome measures was 8 months.
PY - 2013/7
Y1 - 2013/7
N2 - Purpose The purpose of this study is to examine the impact of a Care Management Organization (CMO) Diabetes Disease Management Program (DDMP) in improving diabetes outcomes among high-risk patients with type 2 diabetes (T2DM) in the Bronx, New York. An interventional, nonrandomized study design was used to assess the effectiveness of the DDMP. Patients older than 18 years who had T2DM and an A1C persistently 8% or greater or with a cardiovascular comorbidity were characterized as high risk and received intensive disease management. Patients served as their own controls, with data collection and analysis occurring 12 months prior to and 12 months after enrollment in DDMP. Data collection included screening rates for A1C, low-density lipoprotein (LDL) cholesterol, depression, smoking status, and annual influenza vaccine administration. Changes in A1C and LDL cholesterol were also analyzed. Statistical analyses were conducted using Minitab. McNemar's chi-square and paired t tests were used to assess within-group changes from baseline to final outcomes. Significant improvements in screening rates for A1C, LDL, depression, smoking status, and annual influenza vaccine administration were found among high-risk/intensively managed patients in the DDMP. Improvements in clinical measures were also achieved in this group. Provider and patient satisfaction surveys were positive, with 92% of patients believing that the program helped them better understand their disease. A DDMP among high-risk patients has shown promise in improving the quality of care for patients with diabetes. This program has relevance for other integrated delivery systems that are developing accountable care approaches.
AB - Purpose The purpose of this study is to examine the impact of a Care Management Organization (CMO) Diabetes Disease Management Program (DDMP) in improving diabetes outcomes among high-risk patients with type 2 diabetes (T2DM) in the Bronx, New York. An interventional, nonrandomized study design was used to assess the effectiveness of the DDMP. Patients older than 18 years who had T2DM and an A1C persistently 8% or greater or with a cardiovascular comorbidity were characterized as high risk and received intensive disease management. Patients served as their own controls, with data collection and analysis occurring 12 months prior to and 12 months after enrollment in DDMP. Data collection included screening rates for A1C, low-density lipoprotein (LDL) cholesterol, depression, smoking status, and annual influenza vaccine administration. Changes in A1C and LDL cholesterol were also analyzed. Statistical analyses were conducted using Minitab. McNemar's chi-square and paired t tests were used to assess within-group changes from baseline to final outcomes. Significant improvements in screening rates for A1C, LDL, depression, smoking status, and annual influenza vaccine administration were found among high-risk/intensively managed patients in the DDMP. Improvements in clinical measures were also achieved in this group. Provider and patient satisfaction surveys were positive, with 92% of patients believing that the program helped them better understand their disease. A DDMP among high-risk patients has shown promise in improving the quality of care for patients with diabetes. This program has relevance for other integrated delivery systems that are developing accountable care approaches.
UR - http://www.scopus.com/inward/record.url?scp=84880603669&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84880603669&partnerID=8YFLogxK
U2 - 10.1177/0145721713487259
DO - 10.1177/0145721713487259
M3 - Article
C2 - 23674374
AN - SCOPUS:84880603669
VL - 39
SP - 515
EP - 522
JO - Diabetes Educator
JF - Diabetes Educator
SN - 0145-7217
IS - 4
ER -