Implementation of an Integrated Care Management Pilot Program Improves Diabetes Quality Outcomes after 12 Months
DIABETES(2023)
摘要
Care management efforts focused on patients not achieving quality goals can improve performance in value-based care quality programs, but may pose challenges for integration into routine clinical care. We evaluated a 12-month NP-led care management pilot program (CMPP) to improve outcomes for adults with T2DM and A1c>9% (N=62, 40% male) covered under a value-based care quality program and receiving care at a diabetes center. Visits were scheduled as billable encounters between routine clinical visits. Diabetes quality outcomes (A1c≤9%, BP<140/90, and annual retinal screening) were assessed by CMPP participation. For this pilot program, p<0.05 and p<0.10 defined significance and trend, respectively. The CMPP began in November 2020 with 43% (n=27) participation; participants and non-participants had no baseline differences in age, diabetes duration, or baseline attainment of diabetes quality metrics. CMPP participants had more visits compared to non-participants over the 12 month pilot period (10.4 vs. 4.0, p<.001); 62% of participant visits were virtual vs 47% among non-participants (p=.01). At 12 months, CMPP participants had a significant improvement in % A1c≤9% and trended towards improved annual retinal screening. This integrated NP-led CMPP leveraging virtual care may improve diabetes quality outcomes. Future efforts will focus on scaling and implementation in primary care. Disclosure L.J.Tinsley: None. K.D.Ariyabuddhiphongs: None. E.Halprin: None. J.Beaulieu: None. M.Moreau: None. A.Millan-ferro: None. J.Rizzotto: None. B.Cronin: None. S.N.Mehta: None.
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关键词
diabetes quality outcomes
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