Care Management Processes Important for High Quality Diabetes Care

Abstract

<p> </p> <p><strong>Objective:</strong> Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over three years. </p> <p><strong>Research design and methods:</strong> Repeated cross-sectional study tracking clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic changes in individual CMPs between years by practice. We used Bayesian methods to simultaneously estimate a five-outcome model: A1c, systolic and diastolic blood pressure, guideline-based statin use, and Optimal Diabetes Care (ODC). We control for unobserved time-invariant practice characteristics and secular change. We modeled correlation of errors across outcomes. Statistical significance was identified using 99% Bayesian credible intervals (analogous to p<0.01). </p> <p><strong>Results:</strong> Implementation of 18 of 62 CMPs were associated with statistically significant improvements in patient outcomes. Together, these resulted in 12.1 percent more patients meeting ODC performance measures. Different CMPs affected different outcomes. Three CMPs accounted for 5.7 of 12.1% total ODC improvement, 68% of A1c decrease, 21% of SBP reduction, and 55% of statin use increase: 1) systems for identifying and reminding patients due for testing, 2) after-visit follow-up by a non-clinician, and 3) guideline-based clinician reminders for preventive services during a clinic visit.</p> <p><strong>Conclusions:</strong> Effective quality improvement in primary care focuses on practice redesign that clearly improves diabetes outcomes. Tailoring CMP adoption in primary care provides effective improvement in ODC performance through focused changes in diabetes outcomes. </p>