An all-or-none or “bundled” approach to primary care deployed by Geisinger Health System for patients with diabetes produced better health outcomes, and the benefits happened quickly, according to a study published in The American Journal of Managed Care.
The study measured hazard ratios (HRs) for 4,095 patients enrolled in Geisinger’s Diabetes System of Care, compared with 4,095 patients not enrolled in the program. Adjusted HRs for myocardial infarction (0.77), stroke (0.79), and retinopathy (0.81) were all significantly lower among patients in the diabetes care group. The study found that most of the risk reduction occurred during the first year, which suggests that efforts to change healthcare delivery to improve quality can work quickly.
To accomplish these results, Geisinger did not add extra staff but rather redesigned the roles and responsibilities within the primary care office to have the staff work more together as a team to help the patients accomplish their goals. In this team-based model, the physician is still in charge as the quarterback of the team, but this system uses other team members to perform other tasks so the physician can focus on making complex medical decisions and motivate the patients to meet their goals.
This type of change is not easy, the study’s authors report. Creating system-wide change requires constant evaluation, and improvements must be scalable across a variety of practice settings. Accountability is key, according to their findings. Payment must be prompt to ensure ongoing progress and buy-in, the authors concluded.
The Geisinger results are important in light of soaring incidence rates of type 2 diabetes, which the study notes skyrocketed 40 percent between 2007 and 2010. According to the American Diabetes Association, 26 million Americans have the disease, with most of them suffering from type 2.
Source: Geisinger, June 27, 2014
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