Forum Three: Changes in the U.S. health care system that would facilitate improved care for non-insulin-dependent diabetes mellitus.

At the conclusion of the conference detailed in this supplement, conference attendees participated in one of three fora to discuss an assigned topic and incorporate conference presentations into the discussion. Forum Three, the results of which are reported here, addressed the challenging question of what changes in the U.S. health care system would facilitate improved care for patients with non-insulin-dependent diabetes mellitus (NIDDM). Using the nominal group process-a discussion technique designed to obtain a rank-ordered list of responses to the challenge question from a group of informed persons-Forum Three made the following priority recommendations: 1) Establish universal access to the comprehensive preventive services necessary to optimally manage the estimated 16 million Americans with NIDDM; 2) create a system of co-management between primary and specialty care services; and 3) modify the current health care system to include a program for increased patient and public awareness of the seriousness of NIDDM, special training for primary care residents and practicing physicians in this area, development of standards of care, creation of a central coordinating agency for all aspects of diabetes care, and development of outcome-based goals for patients and providers.