Abstract
Background: Numerous studies have examined the effect of care management (CM) programs on diabetes outcomes such as A1c control. Most evaluations have been small randomized controlled trials; few studies examine how CM translates to real-world settings in terms of success at reaching target populations, or effectiveness for improving outcomes in large populations. The aims of this project are to assess the appropriateness of entry into a diabetes (DM) nurse-delivered CM program in Kaiser Permanente Northern California (KPNC) compared with program guidelines, to determine the proportion who meet program entry criteria, and to compare the trajectory of intermediate outcomes in patients who receive CM to that of similar patients who don’t receive CM.
Methods: KPNC automated databases were used to identify all DM patients from 2000–2005 and to determine whether patients enrolled in CM. We examined whether CM enrollees and non-enrollees met the eligibility criteria for the CM program. Using propensity score matching, we matched CM patients to similar patients who were eligible but did not enter CM. We compared trajectories of A1c, LDL-c, and blood pressure levels of CM patients to those of their matched controls, adjusting for baseline risk factor levels.
Results: Between 2000 and 2005 less than 10% of all KPNC diabetes patients entered CM, representing approximately 25% of all eligible patients. Up to 22% of those in CM each year did not meet program entry criteria. CM patients were similar to the overall DM population in age, gender, blood pressure, and LDL-c levels; they had higher A1c and microalbumin levels. There were small but statistically significant differences in A1c, LDL-c, and blood pressure levels between CM patients and their matched controls 6, 12, and 15 months after program exit. There were significant improvements in CVD risk factor levels in all KPNC DM patients over time, regardless of whether or not they received CM.
Conclusions: While eligibility guidelines for diabetes nurse care management were not strictly adhered to, care management did have a small but significant impact on intermediate outcomes. However, these improvements were small compared to the risk factor improvements over time in the overall DM population.
- Received September 11, 2008.
