Effect of third-party reimbursement on use of services and indexes of management among indigent diabetic patients

Diabetes control improved when inner-city patients received graphic feedback about glycosylated hemoglobin levels

OBJECTIVE

To develop and test an inexpensive visual tool to help patients with diabetes improve glycemic control.

METHODS

A multidisciplinary team developed a 1-page form, the "Take-home Diabetes Record" (THDR), providing feedback to patients by displaying per cent glycosylated hemoglobin (GHb) values graphically over time, with target levels highlighted. Patients with type 2 diabetes in an inner-city clinic were randomized to THDR use (n = 57) or not (n = 70) over 15 months. Self-care activities were discussed, linked with GHb results, and charted at each clinic visit. Initial and final GHb were compared.

RESULTS

Mean GHb fell significantly in THDR patients (-0.94, P =.003), but not in control patients (-0.18, P =.36). Mean GHb decrease was greater in THDR patients (P =.047). A greater proportion of THDR patients (51%) than control patients (18%) achieved a decrease in GHb >/=0.9 (P =.001).

CONCLUSIONS

A graph linking GHb and self-care activities shows promise for improving glycemic control.

Long-term health care outcomes in diabetes. Economic and political implications

With building pressure for cost-containment of medical expenditures, the medical community is finding it increasingly necessary to justify its procedures and systems of care. The analysis of health care outcomes has been extensively applied to diabetes care as a means of determining the process by which optimal outcomes may be achieved. This article reviews basic concepts of outcomes analysis, with differentiation between process measures and outcome measures. A review of the available outcome literature as it pertains to diabetes also is provided.