OBJECTIVES: In 2009 and 2010, 17 primary care sites within 1 healthcare system became patient-centered medical homes (PCMHs), but the sites trained different personnel (pharmacists vs nurses) to improve diabetes care using self-management support (SMS). We report the challenges and successes of our efforts to: 1) assemble a new multipayer (Medicare, Medicaid, commercial) claims dataset linked to a clinical registry and 2) use the new dataset to perform comparative effectiveness research on implementation of the 2 SMS models. STUDY DESIGN: Longitudinal cohort study. METHODS: We lost permission to use private-payer data. Therefore, we used claims from Medicare fee-for-service and Medicare/Medicaid dual-eligible patients merged with chronic disease registry data. We studied 2008 to 2010, which included 1 year pre- and 1 year post the 2009 implementation time period. Outcomes were outpatient and emergency department visits, hospitalizations, care process (use of statin), and 3 intermediate outcomes (glycemic control, blood pressure [BP], and low-density lipoprotein cholesterol [LDL-C]). RESULTS: In our sample of 2826 patients, quality of care improved and utilization decreased over the 2.5 years. Both approaches improved lipid control (LDL-C decreased by an average of 4 mg/dL for pharmacy-SMS and 5.6 mg/dL for nurse-SMS) and diastolic BP (-1.5 mm Hg for pharmacy-SMS and -1.3 mm Hg for nurse-SMS), whereas only the pharmacy-led approach decreased primary care visits (by 0.8 visits). The groups differed slightly on 2 measures (glycated hemoglobin, systolic BP) with respect to the trajectory of improvement over time, but performance was similar by 2.5 years. CONCLUSIONS: Diabetes care improved during PCMH implementation systemwide, supporting both nurse-led and pharmacist-led SMS models.
OBJECTIVES: In 2009 and 2010, 17 primary care sites within 1 healthcare system became patient-centered medical homes (PCMHs), but the sites trained different personnel (pharmacists vs nurses) to improve diabetes care using self-management support (SMS). We report the challenges and successes of our efforts to: 1) assemble a new multipayer (Medicare, Medicaid, commercial) claims dataset linked to a clinical registry and 2) use the new dataset to perform comparative effectiveness research on implementation of the 2 SMS models. STUDY DESIGN: Longitudinal cohort study. METHODS: We lost permission to use private-payer data. Therefore, we used claims from Medicare fee-for-service and Medicare/Medicaid dual-eligible patients merged with chronic disease registry data. We studied 2008 to 2010, which included 1 year pre- and 1 year post the 2009 implementation time period. Outcomes were outpatient and emergency department visits, hospitalizations, care process (use of statin), and 3 intermediate outcomes (glycemic control, blood pressure [BP], and low-density lipoprotein cholesterol [LDL-C]). RESULTS: In our sample of 2826 patients, quality of care improved and utilization decreased over the 2.5 years. Both approaches improved lipid control (LDL-C decreased by an average of 4 mg/dL for pharmacy-SMS and 5.6 mg/dL for nurse-SMS) and diastolic BP (-1.5 mm Hg for pharmacy-SMS and -1.3 mm Hg for nurse-SMS), whereas only the pharmacy-led approach decreased primary care visits (by 0.8 visits). The groups differed slightly on 2 measures (glycated hemoglobin, systolic BP) with respect to the trajectory of improvement over time, but performance was similar by 2.5 years. CONCLUSIONS:Diabetes care improved during PCMH implementation systemwide, supporting both nurse-led and pharmacist-led SMS models.
Authors: Kaveh G Shojania; Sumant R Ranji; Kathryn M McDonald; Jeremy M Grimshaw; Vandana Sundaram; Robert J Rushakoff; Douglas K Owens Journal: JAMA Date: 2006-07-26 Impact factor: 56.272
Authors: Lillian C Min; David B Reuben; Catherine H MacLean; Paul G Shekelle; David H Solomon; Takahiro Higashi; John T Chang; Carol P Roth; Caren J Kamberg; John Adams; Roy T Young; Neil S Wenger Journal: J Am Geriatr Soc Date: 2005-10 Impact factor: 5.562
Authors: Takahiro Higashi; Neil S Wenger; John L Adams; Constance Fung; Martin Roland; Elizabeth A McGlynn; David Reeves; Steven M Asch; Eve A Kerr; Paul G Shekelle Journal: N Engl J Med Date: 2007-06-14 Impact factor: 91.245
Authors: Laura A Petersen; Lechauncy D Woodard; Louise M Henderson; Tracy H Urech; Kenneth Pietz Journal: Circulation Date: 2009-06-01 Impact factor: 29.690
Authors: Lillian C Min; Neil S Wenger; Constance Fung; John T Chang; David A Ganz; Takahiro Higashi; Caren J Kamberg; Catherine H MacLean; Carol P Roth; David H Solomon; Roy T Young; David B Reuben Journal: Med Care Date: 2007-06 Impact factor: 2.983