A Systematic Approach to Risk Stratification and Intervention Within a Managed Care Environment Improves Diabetes Outcomes and Patient Satisfaction

A Systematic Approach to Risk Stratification and Intervention Within a Managed Care Environment Improves Diabetes Outcomes and Patient Satisfaction Charles M. Clark, Jr. , MD 1 , James W. Snyder , MD 2 , Robert L. Meek , MS 3 , Linda M. Stutz , RN, MBA 4 and Christopher G. Parkin , MS 5 1 Indiana University, Indianapolis, Indiana; 2 VA Southern Nevada Healthcare System, Las Vegas, Nevada; 3 Roche Diagnostics Corporation; 4 Meszzia Corporation; 5 CGParkin Communications, Indianapolis, Indiana. Abstract OBJECTIVE —To determine whether a comprehensive diabetes management program that included risk stratification and social marketing would improve clinical outcomes and patient satisfaction within a managed care organization (MCO). RESEARCH DESIGN AND METHODS —The 12-month prospective trial was conducted at primary care clinics within a MCO and involved 370 adults with diabetes. Measurements included 1 ) the frequency of dilated eye and foot examinations, microalbuminuria assessment, blood pressure measurement, lipid profile, and HbA 1c measurement; 2 ) changes in blood pressure, lipid levels, and HbA 1c levels; and 3 ) changes in patient satisfaction. RESULTS —Complete data are reported for the 193 patients who had been enrolled for 12 months; life table analysis is reported for all patients who remained enrolled at the study’s end as well as for a comparative control group of 623 patients. For the 193 patients for whom 12-month data were available, the number of patients in the low-risk category (HbA 1c 8% at baseline had a change in treatment regimen. Patients at the highest risk for coronary heart disease (LDL >130 mg/dl) decreased from 25.4% at baseline to 20.2%. Patients with a blood pressure