Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care. (October 2017)

• Record Type: Journal Article
• Authors: Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A.; Chen, Qiaoling; Piette, John
• Is Part Of: Journal of primary care & community health. Volume 8:Number 4(2017:Oct.)
• Page Start: 312
• Page End: 318
• Publication Date: 2017-10
• Subjects: care management -- diabetes -- obesity -- chronic disease -- primary care; Primary health care -- Periodicals; Primary health care -- United States -- Periodicals; Community health services -- Periodicals; Community health services -- United States -- Periodicals; 362.12
• DOI: 10.1177/2150131917715536
• Languages: English
• ISSNs: 2150-1319

Abstract

Background: To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed.Methods: In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight.Results: Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c <7% (95% CI, 3%-20%), and 26% of obese nondiabetic patients in chronic care management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%).Conclusions: These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.