Although previous work suggests that high performing practices focus on proactive patient outreach, the specific care management processes (CMP) that improve diabetes outcomes remain unclear. We evaluated 60 CMP from a state-wide practice survey in 2017 and 2019. Previously validated, the survey included 586 practices in 2017 (71% response, N=415) and 627 practices in 2019 (71% response, N= 445). Electronic health record data for A1c, blood pressure (BP), and lipid management were extracted for all patients with type 1 or type 2 diabetes in the practices. The longitudinal data set included 395 practices providing care to 204,745 patients. We used a longitudinal Bayesian model to correlate CMPs with A1c, systolic/diastolic BP, and probability of taking a statin. Patient outcomes were controlled for age, sex, diabetes type, insurance, comorbidity, community-level race-ethnicity, wealth, education, and income. Practices were controlled for rurality, size, FQHC status, system size, and practice-level random effects. Significance was reduced to <.01 for multiple comparisons. Although 7 CMPs significantly improved the overall diabetes performance measures for an average practice, CMPs affected individual outcomes differently. A1c improved by: 1) implementing a systematic approach to identifying and reminding patients when they were due for testing, and 2) having a nurse or care manager provide after visit follow up. BP was reduced by: 1, 2, and 3) tracking lab tests, 4) using checklists in the practice for required testing, and 5) guideline based reminders for preventive services. Statin use increased by: 5, and 6) screening for substance-abuse, and 7) a formal process for measuring performance. Together, CMPs with a statistically significant impact on performance measures accounted for a drop in average A1c in a practice from 7.39 to 7.25 (P<.01) BP from 127/75 to 121/71 (P<.01) and a 3.9% (P<.01) statin use increase. CMP 1 and 2 exemplify specific proactive patient outreach processes proven to improve diabetes care delivery. Disclosure K. A. Peterson: Board Member; Self; Treatment.com International Inc. C. Carlin: None. L. Solberg: None. M. Eder: None. Funding National Institutes of Health (R18DK110732)
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