Item #7

The Diabetes Team Works, Saves $27,000 per Patient

The diabetes Teamwork In Action saves $27,000 in health care costs per patient   

For patients with diabetes, disease management is a lifelong endeavor that requires attention to multisystem effects. The National Diabetes Education Program -- a joint venture of the National Institutes of Health and the Centers for Disease Control and Prevention -- proposes that leaders in the health care community collaborate with patients. These newly formed teams will provide continuous and aggressive therapeutic intervention and reduce the human and economic toll that can be exacted by this serious but controllable disease. 

In a study of diabetes care in a managed care setting, the team members used a population-based approach. Hospital patients were stratified into three levels based on comorbidity, complexity of disease, risk factors, and numbers of resources needed. Data analysis indicated that each patient experienced a gross savings of $50 per month and that there was an 18% decrease annually in hospital admissions.  

The activities of a lipid management team in a large Veterans Affairs clinic, consisting of a pharmacist, an NP, a dietitian, a cardiologist, and a clinical psychologist -- with a registered nurse serving as team leader -- were the focus of yet another study.

Researchers found that the team was able to yield significant positive results in lowering cholesterol, compared with the efforts of traditional, non-team care.

Any diabetes management team may consider the cost-effective approach of stepped management, in which precise time lines are set to achieve and maintain treatment goals. With this type of management, it is estimated, the lifetime savings in health care costs per patient can total nearly $27,000.

Other Aspects of Team Management

One factor to remember is that the central team member is the patient, who will be an integral part of his or her own health care as provider and decision maker. Necessary areas for self-management education include treatment options, effective use of medications, incorporating healthful changes in nutrition and exercise into lifestyle, glucose monitoring, and preventing, detecting, and treating chronic complications.

Similarly, the role that trained community health workers can play should not be overlooked. In one study, high-risk patients with diabetes who had not improved under office-based care experienced improved body weight and blood glucose values via weekly or monthly contact with community workers collaborating with a clinic-based team.^[14] A similar study of hypertension management showed that with community group involvement, patients were more likely to adhere to therapy and keep appointments.^[15]

Conclusion

Multidisciplinary team management based on scientifically grounded practice guidelines presents an outstanding opportunity for policy makers to improve the health of people with diabetes and ultimately reduce the overall costs of diabetes care. Approaching diabetes care as a team has endless possibilities and can be flexible enough to meet the needs of the community and, most importantly, the individual patient. 

* This article is based on Centers for Disease Control and Prevention. Team care: Comprehensive lifetime management for diabetes. Atlanta, Ga: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2001. The remaining references were cited in the report. Clinician Reviews 12(2):49-53, 2002

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Did You Know: 

Transient ischaemic attacks (Mini-strokes) occur between two and six times more frequently in people with diabetes. 

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