Diabetes Ten City Challenge: Final economic and clinical results

Abstract

ObjectiveTo assess the economic and clinical outcomes for the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes. DesignQuasiexperimental observational analysis, pre–post comparison. SettingEmployers at 10 distinct geographic sites contracting with pharmacy providers in the community setting. Participants573 patients with diabetes who had baseline and year 1 medical and pharmacy claims and two or more documented visits with pharmacists. InterventionsCommunity-based pharmacists provided patient self-management care services via scheduled consultations within a collaborative care management model. Main outcome measuresChanges in health care costs for employers and beneficiaries and key clinical measures. ResultsAverage total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Statistically significant improvements were observed for key clinical measures, including a mean glycosylated hemoglobin decrease from 7.5% to 7.1% (P = 0.002), a mean low-density lipoprotein cholesterol decrease from 98 to 94 mg/dL (P < 0.001), and a mean systolic blood pressure decrease from 133 to 130 mm Hg (P < 0.001) over a mean of 14.8 months of participation in the program. Between the initial visit and the end of the evaluation period, influenza vaccination rate increased from 32% to 65%, eye examination rate increased from 57% to 81%, and foot examination rate increased from 34% to 74%. ConclusionDTCC successfully implemented an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies. Positive clinical and economic outcomes were identified for 573 patients who participated in the program for at least 1 year, compared with baseline data.