The Effectiveness of Pay-for-Performance Program of Diabetes Care for Psychiatric Patients: A Regional Psychiatric Hospital Experience

Background: The Pay-for-performance (P4P) program of diabetes care has demonstrated successful outcomes in patients with type 2 diabetes. However, the effectiveness of this multidisciplinary care model for psychiatric patients has never been evaluated. The objective of this study is to examine the effectiveness of P4P program of diabetes for psychiatric patients with diabetes. Methods: This study utilized a retrospective cohort design to examine the effectiveness of P4P program of diabetes care for psychiatric patients with diabetes. The participants’ HbA1c (hemoglobin A1c) data of the fourth quarter in 2018 were used as baseline value, while P4P program was not applied yet. HbA1c data of every quarter in 2019 were collected. Generalized estimating equations (GEE) was used to analyze the change of HbA1c level. Results: The HbA1c level increased slightly in the first quarter, and then decreased gradually since the second quarter. The HbA1c level was significantly lower in the fourth quarter after P4P program intervention (p < 0.05). Conclusion: P4P program of diabetes care is also effective on psychiatric patients with diabetes, and this multidisciplinary care model could be encouraged and promoted for psychiatric patients with diabetes.

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Cost-effectiveness of telemedicine care for patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211042542 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110425

Author(s):

Manal Faleh AlMutairi ◽

Ayla M. Tourkmani ◽

Alian A. Alrasheedy ◽

Turki J. ALHarbi ◽

Abdulaziz M. Bin Rsheed ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cost Effectiveness ◽

Incremental Cost ◽

Diabetes Care ◽

Hba1c Level ◽

Care Model ◽

Traditional Care

Background and aim: Telemedicine could be used to provide diabetes care with positive clinical outcomes. Consequently, this study evaluated the cost-effectiveness of telemedicine for patients with uncontrolled type 2 diabetes mellitus (i.e. HbA1c >9). Patients and methods: This was a retrospective chart review of patients with uncontrolled type 2 diabetes attending an outpatient integrated care clinic. The study consisted of two arms, namely a telemedicine care model and a traditional care model with 100 patients in each. The clinical effectiveness (i.e. reduction in HbA1c) and the total cost in both arms were determined, and the incremental cost-effectiveness ratio was calculated. This study adopted propensity score matching. Results: The patients in the telemedicine care model had a mean reduction in their HbA1c level of 1.82 (95% CI = 1.56–2.09, p < 0.001), while those in the traditional care model had a mean reduction of 1.54 (95% CI = 1.23–1.85, p < 0.001). Consequently, the incremental effect was 0.28 (95% CI = −0.194 to 0.546). The mean total costs were SAR 4819.76 (US$1285.27) and SAR 4150.69 (US$1106.85) for patients in the telemedicine and traditional care models, respectively. Consequently, the incremental cost was SAR 669.07 (US$178.42) [95% CI = SAR 593.7 (US$158.32)–SAR 1013.64 (US$270.30)]. The ICER was estimated to be SAR 2372.52 (US$632.67) per 1% reduction in the level of HbA1c. Moreover, the telemedicine care model resulted in a higher cost and better outcome (i.e. reduction in the HbA1c level) with an 81.80% confidence level. Conclusion: Telemedicine care is cost-effective in managing type 2 patients with poorly controlled diabetes. Consequently, we believe that telemedicine care can be further expanded and incorporated into routine diabetes care.

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Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care

Journal of Evaluation in Clinical Practice ◽

10.1111/j.1365-2753.2009.01178.x ◽

2010 ◽

Vol 16 (4) ◽

pp. 700-706 ◽

Cited By ~ 4

Author(s):

Mohammad A. Khan ◽

Arthur T. Evans ◽

Sejal Shah

Keyword(s):

Diabetes Care ◽

Chronic Care Model ◽

Chronic Care ◽

Care Model ◽

Uninsured Patients ◽

Patients With Diabetes

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Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.02.14 ◽

2021 ◽

Vol 14 (2) ◽

pp. 269-276

Author(s):

Rui-Fang Feng ◽

◽

Ya-Lu Liu ◽

Qing Xu ◽

Lei Qiao ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Hba1c Level ◽

Onset Age ◽

Diabetes Onset ◽

Patients With Diabetes ◽

High Hba1c ◽

Independent Risk Factors ◽

Hba1c Levels

AIM: To assess the effect of age at diabetes onset and uncontrollable high HbA1c levels on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. METHODS: This was a cross-sectional survey of diabetic patients in Subei district, China. Data covering physical measurements, fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1c), blood lipid, urinary albumin/creatinine ratio (UACR), ocular fundus examination, and diabetes treatment records were collected. An independent sample t-test were used to analyze differences. A Logistic regression analysis was applied to study the independent risk factors of DR. RESULTS: A total of 1282 patients with type 2 DM were enrolled, and 191 cases had DR (14.9%). The age at diabetes onset, education level, alcohol consumption, HbA1c level, UACR level, and hypoglycemic drugs were independent influencing factors for DR. The older the onset of diabetes, the less likely to develop DR (OR: 0.958, 95%CI: 0.942-0.975, P=0.000). Patients were then divided in terms of age at diabetes onset as follows: <50y, 50-59y, 60-69y, and ≥70y. Compared with diabetes onset age <50y, 50-59y (OR: 0.463, 95%CI: 0.306-0.699, P=0.000), 60-69y (OR: 0.329, 95%CI: 0.203-0.535, P=0.000) and ≥70y (OR: 0.232, 95%CI: 0.094-0.577, P=0.002) were at a lower risk of DR. The prevalence of DR was highest in patients with diabetes onset age <50y (29.5%, P<0.05). The HbA1c level (8.67±1.97)% and proportion of insulin injection (52.5%) in patients with diabetes onset <40y were higher than in patients with older diabetes onset age (P<0.05). CONCLUSION: Diabetes onset at an earlier age and uncontrollable high HbA1c level could be independent risk factors for DR.

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Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial (Preprint)

10.2196/preprints.7692 ◽

2017 ◽

Author(s):

Shinyi Wu ◽

Kathleen Ell ◽

Haomiao Jin ◽

Irene Vidyanti ◽

Chih-Ping Chou ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Usual Care ◽

Diabetes Care ◽

Functional Disability ◽

Safety Net ◽

P Value ◽

Depression Care ◽

Care Model

BACKGROUND Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.

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Changes in Blood Glucose Level After Steroid Injection for Musculoskeletal Pain in Patients With Diabetes

Annals of Rehabilitation Medicine ◽

10.5535/arm.2020.44.2.117 ◽

2020 ◽

Vol 44 (2) ◽

pp. 117-124 ◽

Cited By ~ 2

Author(s):

Woo-Yong Shin ◽

Min-Ji An ◽

Nam-Gyu Im ◽

Kyung-Rok Oh ◽

Yuri Choe ◽

...

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Injection Site ◽

Glucose Level ◽

Hba1c Level ◽

Steroid Injection ◽

Demographic Data ◽

Factors Affecting ◽

Patients With Diabetes

Objective To investigate changes in blood glucose level after steroid injection in patients with type 2 diabetes mellitus (DM) and factors affecting those changes.Methods We retrospectively studied 51 patients with type 2 DM who underwent steroid injection for shoulder and back pain. Mean fasting blood sugar (FBS) levels for 7 days before steroid injection was used as the baseline blood glucose level, which was compared with FBS levels for 14 days after steroid injection. We compared the differences in blood glucose changes between HbA1c >7% and HbA1c ≤7% groups and those between insulin and non-insulin treated groups. Demographic data, injection site, and steroid dose were analyzed.Results Compared to baseline, blood glucose significantly (p=0.012) elevated 1 day after steroid injection but not 2 days after injection. In the HbA1c >7% and insulin groups, blood glucose was significantly increased 1 day after injection compared to that in the HbA1c ≤7% (p=0.011) and non-insulin (p=0.024) groups, respectively. Higher HbA1c level before injection was significantly (p=0.003) associated with the degree of blood glucose increase 1 day after injection. No significant differences were noted in the degree of blood glucose increase according to injection site or steroid dose.Conclusion Higher HbA1c level was associated with greater elevation in blood glucose 1 day after steroid injection. Careful monitoring of blood glucose is required on the first day after steroid injection in patients with poorly controlled DM.

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Type 2 diabetes in primary care

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738017713790 ◽

2017 ◽

Vol 10 (12) ◽

pp. 705-712

Author(s):

Hermione Price

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

Primary Care ◽

Diabetes Care ◽

Cost Savings ◽

Patients With Diabetes ◽

The Uk

Type 2 diabetes is common, and its prevalence is increasing. Most patients with type 2 diabetes are managed entirely in primary care. The National Diabetes Audit has provided evidence of large variations across the UK in the standard of available care in the community for patients with diabetes. Good diabetes care can prevent or delay complications and, as well as cost savings, this results in a better quality of life for patients. This article provides an overview of type 2 diabetes and the National Institute for Health and Care Excellence guidance for treatment proposed in 2015.

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Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094648 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4648

Author(s):

Hsiu-Ling Huang ◽

Chuan-Yu Kung ◽

Shun-Mu Wang ◽

Pei-Tseng Kung ◽

Yen-Hsiung Lin ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Cohort Study ◽

Body Mass ◽

Pay For Performance ◽

Death Risk ◽

Risk Of Death ◽

Patients With Diabetes ◽

Underweight Patients

Background: The diabetes patients enrolled in the pay-for-performance (P4P) program demonstrate reduced risk of death. Body mass index (BMI) is a risk factor of all-cause death. This study investigates the effects of BMI and P4P on the risk of death in type 2 diabetes patients. Methods: This is a retrospective cohort study. The study population includes the 3-wave National Health Interview Survey in Taiwan. A total of 6354 patients with diabetes aged ≥ 20 years were enrolled and followed up until the end of 2014. Results: The highest mortality rate per 1000 person-years was 61.05 in the underweight patients with diabetes. A lower crude death rate was observed in the P4P participants than non-P4P participants. The risk of death was 1.86 times higher in the underweight patients with diabetes than that in the normal weight group (95% CI: 1.37–2.53) and was lower in the P4P participants, as compared to the non-participants (HR: 0.55, 95% CI: 0.44–0.69). The most significant effect of joining the P4P program in reducing death risk was found in the underweight patients with diabetes (HR: 0.11, 95% CI: 0.04–0.38), followed by the obesity group (HR: 0.30, 95% CI: 0.17–0.52). Conclusions: Different effects of joining the P4P program on reducing death risk were observed in the underweight and obesity groups. We strongly recommend that patients with diabetes and without healthy BMIs participate in the P4P program.

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Building the evidence for integrated care for type 2 diabetes: a pilot study

Australian Journal of Primary Health ◽

10.1071/py15020 ◽

2016 ◽

Vol 22 (5) ◽

pp. 409 ◽

Cited By ~ 2

Author(s):

Jessica L. Browne ◽

Jane Speight ◽

Carina Martin ◽

Christopher Gilfillan

Keyword(s):

Type 2 Diabetes ◽

Integrated Care ◽

Diabetes Care ◽

Controlled Trial ◽

Care Model ◽

Service Setting ◽

Quality Of Diabetes Care ◽

The Impact

Integrated care models have the potential to reduce fragmentation in the health system and improve outcomes for people with type 2 diabetes. A pilot evaluation of an integrated care model for people with type 2 diabetes in Melbourne, Australia, is reported on. Two studies were conducted: (1) a 6-month pilot randomised controlled trial (n=56) evaluating the impact of the integrated care model relative to hospital outpatient clinics; and (2) a cross-sectional study (n=92) of patients attending the two services. The primary outcome was diabetes-specific distress; secondary outcomes were perceived quality of diabetes care, diabetes-specific self-efficacy and glycated haemoglobin (HbA1c). There was no effect of service setting on diabetes-specific distress. Participants from the integrated care setting perceived the quality of diabetes care to be higher than did participants from the hospital clinics. Significant HbA1c improvements were observed over time, but with no effect of service setting. The model holds promise for people with type 2 diabetes who need more specialist/multidisciplinary care than can be provided in primary care. Patients’ evaluations of the quality of diabetes care received at the integrated care service are very positive, which is likely to be one of the key strengths of the integrated model.

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