Berg Gregory D, Wadhwa Sandeep
McKesson Corp., 335 Interlocken Parkway, Broomfield, CO 80021, USA.
Manag Care. 2002 Jun;11(6):42, 45-50.
The medical cost of diabetes in the United States in 1997 was at least $98 billion. This study illustrates the behavioral change and medical-care utilization impact that occurs in a community-based setting of a diabetes disease-management program that is applied to program participants in a health insurance plan's health maintenance organization and preferred provider organization.
A historical control comparison of diabetes-management participants.
One hundred twenty-seven identified diabetes patients are followed from baseline through 1 year. Differences in behavior are compared at program intake and at a 6-month reassessment. Differences in medical-service utilization are compared in the baseline year and the year subsequent to program enrollment. Poisson multivariate-regression models are estimated for counts of inpatient, emergency department, physician evaluation and management, and facility visits, while also controlling for potential confounders.
Behaviors improved between program intake and the 6-month reassessment. From patient reports, the number of participants having a hemoglobin A1c test increased by 44.9 percent (p < .001), and there was a 53.2-percent decrease in symptoms of hyperglycemia (p = .002). From medical claims after program enrollment, a drop occurred during the program year in every dimension of medical-service utilization. Regression results show that in-patient admissions decreased by 391 (p < .001) per 1,000 for each group, while controlling for age, length of membership, and the number of comorbid claims for congestive heart failure. In the analysis of costs that were pre- and post-enrollment, which included disease-management program costs, a 4.34:1 return on investment was calculated.
The diabetes program provides patients with comprehensive information and counseling relative to practicing self-management of diabetes through a number of integrated program components. This study strongly suggests that the implementation of such a program is associated with positive behavioral change and, thus, with substantial reduction in medical-service utilization. In addition, the intervention resulted in a net decrease in direct medical costs.
1997年美国糖尿病的医疗费用至少为980亿美元。本研究阐述了在基于社区的糖尿病疾病管理项目中发生的行为变化和医疗服务利用影响，该项目应用于健康保险计划的健康维护组织和优选提供者组织中的项目参与者。
对糖尿病管理参与者进行历史对照比较。
127名确诊的糖尿病患者从基线开始随访1年。在项目开始时和6个月的重新评估时比较行为差异。在基线年份和项目登记后的年份比较医疗服务利用差异。对住院、急诊科、医生评估与管理以及机构就诊次数进行泊松多元回归模型估计，同时控制潜在的混杂因素。
在项目开始时和6个月的重新评估之间，行为有所改善。根据患者报告，进行糖化血红蛋白检测的参与者人数增加了44.9%（p <.001），高血糖症状减少了53.2%（p =.002）。从项目登记后的医疗理赔来看，在项目年度内医疗服务利用的各个方面都有所下降。回归结果显示，在控制年龄、参保时长和充血性心力衰竭合并症理赔数量的情况下，每组每1000人中住院人数减少了391人（p <.001）。在对登记前后成本（包括疾病管理项目成本）的分析中，计算出投资回报率为4.34:1。
糖尿病项目通过多个综合项目组成部分，为患者提供与糖尿病自我管理实践相关的全面信息和咨询。本研究有力地表明，实施这样一个项目与积极的行为改变相关，因此与医疗服务利用的大幅减少相关。此外，干预导致直接医疗成本净下降。
