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J Prim Care Community Health. 2017 Oct;8(4):312-318. doi: 10.1177/2150131917715536. Epub 2017 Jun 23.

Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

Author information

1
1 University of Colorado Denver School of Medicine, Aurora, CO, USA.
2
2 Michigan State University College of Human Medicine, East Lansing, MI, USA.
3
3 University of Michigan, Ann Arbor, MI, USA.
4
4 University of Alberta School of Medicine, Edmonton, Alberta, Canada.
5
5 Kaiser Permanente Southern California, Pasadena, CA, USA.
6
6 Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.

Abstract

BACKGROUND:

To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed.

METHODS:

In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight.

RESULTS:

Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c <7% (95% CI, 3%-20%), and 26% of obese nondiabetic patients in chronic care management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%).

CONCLUSIONS:

These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

KEYWORDS:

care management; chronic disease; diabetes; obesity; primary care

PMID:
28645227
PMCID:
PMC5932733
DOI:
10.1177/2150131917715536
[Indexed for MEDLINE]
Free PMC Article

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