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fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Reed, H. Lester; Bernard, Elaine (2005)
Publisher: Co-Action Publishing
Journal: International Journal of Circumpolar Health
Languages: English
Types: Article
Subjects: cardiovascular, community, Diabetic, medical group, multivariable
Objective. To evaluate a community-based, not-for-profit medical group’s effectiveness with diabetic management while using an electronic medical record and financial incentives. Design. Descriptive retrospective study over 2 years with published reference standards. Methods. There were 5,316 diabetic patients in the medical group (MG) compared with 5,069 diabetic patients reported in the literature (CT). The main outcome measures included serum hemoglobin A1C (HbA1C), total (TC), low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) cholesterol, and clinic measures of systolic (SBP) and diastolic blood pressure. We determined a mean 10-year composite multivariable cardiovascular risk score based upon these parameters. Results. The mean MG serum HbA1C (7.10±0.02; 8.18±0.23%), TC (193.2±0.64; 218.3±6.09 mg/dl), LDL-C (109.2±0.52; 137.8±4.24 mg/dl), and SBP (132.8±0.25; 141.6±2.36 mmHg) were below those for the CT (p<0.001). The MG mean overall coronary heart disease risk of 14.9±1.4% over 10 years was below that for the CT group of 22.7±2.3%, representing a 34.7±4.4% reduction (p<0.0002). The electronic medical record and the use of a financial award may have contributed to these results. Conclusion. Improvement of cardiovascular risk variables can be achieved in the primary care setting. Electronic tools and incentives may facilitate this improvement.(Int J Circumpolar Health 2005; 64(1):26-37)Keywords: cardiovascular, community, Diabetic, medical group, multivariable
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. McGlynn EA, Asch SM, Adams, J, Keesey J, Hicks, J, Decristofaro A, Kerr EA.The quality of health care delivered to adults in the United States. NEJM 2003;348:2635-2645.
    • 2. George PB, Tobin KJ, Corpus RA, Devlin WH, O'Neill WW. Treatment of cardiac risk factors in diabetic patients: How well do we follow the guidelines? Am Heart J 2001;142(5):857-63.
    • 3. Schumacher C, Davidson M, Ehrsam G. Cardiovascular disease among Alaska Natives: a review of the literature. Int J Circumpolar Health 2003;62(4): 343-62.
    • 4. Naylor JL, Schraer CD. Diabetes among Alaska natives: a review. Int J Circumpolar Health 2003;62(4): 363-387
    • 5. Näyhä S. Cold and the risk of cardiovascular disease. A review. Int J Circumpolar Health 2002;61(4):373- 380.
    • 6. Gaede P, Vedel P, Larsen N, Jensen GVH, Paving H, Pederson O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM 2003;348:383-93.
    • 7. Collins R, Armitage CR, Sleight PS, Peto R. Heart Protection Study Collaborative Group. Heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. Lancet 2003;361(9374): 2000-16.
    • 8. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. (UKPDS 33). Lancet 1998;352:837-53
    • 9. Narayan KMV, Boyle JP, Thompson, TJ, Sorensen SW,Williamson DF. Lifetime risk for diabetes in the United States. JAMA 2003;290:1884-1890.
    • 10. Schmidt S, Burns C, Feller DB, Chang K, Hernandez B, McCarthy J, Burg MA. Evaluation of a quality improvement intervention for diabetes management. J for Healthcare Quality 2003;25(3):26-32.
    • 11. McCullough DK, Price MJ, Hindmarsh M, Wagner EH.A population-based approach to diabetes management in a primary care setting: early results and lessons learned. American College of Physicians, Effective Clinical Practice, Available at http://www. acponline.org/journals/ecp/augsep98/population.htm. Accessed 16 April, 2004
    • 12. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century.Washington D.C.: National Academy Press, 2001.
    • 13. UK Prospective Diabetes Study Group. Cost effectiveness of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40 BMJ 1998;317(7160):720-6.
    • 14. Epstein AM, Lee TH, Hamel MB. Paying physicians for high-quality care. NEJM 2004;350:406-410.
    • 15. Jencks SF, Huff ED, Cuerdon T. Change in quality of care delivered to medicare beneficiaries, 1998- 1999 to 2000-2001. JAMA 2003;289:305-312.
    • 16. Quality Improvement Organization resource page. Centers for Medicare and Medicaid Web site. Available at http://www.cms.hhs.gov/qio/default.asp. Accessed 16 April, 2004.
    • 17. Casalino L, Gillies R, Shortel S, Schmittdiel JA, Bodenheimer T, Robinson JC, Rundall T, Oswald N, Schauffler H, Wang MC. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA 2003;289:434-441.
    • 18. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kennel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97(18):1837-1847.
    • 19. Medical College of Wisconsin, Division of General Internal Medicine. Online Clinical Calculator: Coronary Heart Disease Risk Calculator. Available at www.intmed.cw.edu/clincalc/heartrisk.html.Accessed 16 April, 2004.
    • 20. Stevens, RJ, Coleman RL, Adler, AI, Stratton IM, Matthews, DR, Holman, RR. Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66. Diabetes Care 2004;27:201-207.
    • 21. UKPDS Risk Engine. The Oxford Centre for Diabetes, Endocrinology and Metabolism. Diabetes Trials Unit. Available at http://www.dtu.ox.ac.uk. riskengine/download.html.Accessed 16 April, 2004.
    • 22. National Center Health Statistics, MD. Available at http://www.cdc.gov/nchs/fastats/smoking.htm. Accessed 16 April, 2004.
    • 23. Haffner, SM, Lehto S, Röonnemaa t, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with Type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. NEJM 1998;339:229-234.
    • 24. The American Diabetes Association. Clinical Practice Recommendation 2001: Standards of medical care in diabetes. Diabetes Care 2004;27(Suppl 1):S15- S35.
    • 25. Hurst T, Lee R. Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: mechanisms and management.Ann Intern Med 2003;139:824-834.
    • 26. National cholesterol education program.Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Available at http:// hp2010.nhlbihin.net/atpiii/calculator.asp. Accessed 16 April, 2004
    • 27. Smith NL, Chen L, Au DH, McDonell M, Fihn SD. Cardiovascular risk factor control among veternans with diabetes: the amulatory care quality improvement project. Diabetes Care 2004;27 Suppl 2:B33-8.
    • 28. Wagner EH, Sandlu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effects of improved glycemic control and utilization. JAMA 2001;285(2): 182-189.
    • 29. Centers for Disease Control and prevention 2002 diabetes: disabling, deadly, and on the rise: national diabetes fact sheet 2002.Available at www.cdc.gov/ diabetes/pubs/English.htm.Accessed 16 April, 2004.
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