Quality Standards for Diabetes Care Toolkit

Diabetes management in a health maintenance organisation (HMO)

Kaiser Permanente (Pleasanton, CA, USA), a large HMO in the USA, is using a population-based approach to improve outcomes for its 13,000 patients with diabetes. This innovative programme assists primary care teams to improve the delivery of diabetes care. Based on an integrated chronic care model, the programme includes an on-line registry of patients, evidence-based guidelines for routine diabetes care, improved support for patient self-management, and practice re-design that incorporates group visits. Results evidence improvements in the following areas:

retinal screening rates increased from 56% to 70%

renal screening rates increased from 18% to 68%

foot exam rates increased from 18% to 82%

HbA1c testing rates increased from 72% to 92%.
Synopsis: An evaluation of the effectiveness of a cluster visit model led by a diabetes nurse specialist for delivering outpatient care management to adult patients with poorly controlled diabetes aged 16–75 years who had either poor glycaemic control (HbA1c >69 mmol/mol) or no HbA1c test performed during the previous year. Intervention subjects received multidisciplinary outpatient diabetes care management delivered by a diabetes nurse specialist, a psychologist, a nutritionist, and a pharmacist in cluster visit settings of 10–18 patients/month for six months. This six-month cluster visit group model of care for adults with diabetes improved glycaemic control, self-efficacy, and patient satisfaction and resulted in a reduction in health care utilisation after the programme (Sadur et al 1999).