Longitudinal assessment of a XXXX care management system in an integrated health network.

@entity1 @entity165 @entity6 @entity2412
OBJECTIVE: To describe the results of longitudinal assessment of the results of a disease management process developed in a large integrated health care system that successfully improved care for @entity1 with @entity6 . Outcome measures included rates of testing of hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL), rate of annual eye exams, and LDL and HbA1c values. METHODS: Intermountain Health Care (IHC) initiated the development of a @entity6 Care Management System (DCMS) in early 1998. The DCMS was developed as a comprehensive population-based disease management system. It includes provider education programs; performance feedback to physicians; clinical quality performance incentives for physicians; @entity1 education programs; @entity1 incentive, reminder systems to encourage compliance with best care process models; and tracking of physician behavior change and @entity1 compliance with @entity6 therapy. A multifaceted intervention and education approach was chosen because of the complexity of the @entity6 treatment process. RESULTS: The percentage of @entity1 with at least one annual HbA1c test increased from 78.5% in 1998 to 90.5% in 2002. During the same time period, the percentage of @entity1 whose most recent HbA1c was less than 7.0 increased from 33.5% to 52.8%, average HbA1c decreased from 8.1 to 7.3, and the percentage of @entity1 whose most recent HbA1c was greater than 9.5 decreased from 34.6% to 21.4%. The percentage of @entity1 who had an LDL @entity165 screening test within the prior 2 years increased from 65.9% in 1998 to 91.7% in 2002. During the same time period, the percentage of @entity1 whose most recent LDL @entity165 was less than 130 mg/dL increased from 39.9% to 69.8%. The percentage of @entity6 @entity1 who had an annual eye exam increased from 52% in 1998 to 62% in 2002. CONCLUSION: A multifaceted approach to improving @entity6 management has led to improved performance in clinical measures related to @entity6 care that have been shown to reduce the risk of @entity1 with @entity6 developing @entity2412 . All components of the @entity6 management continuum of care, including primary care physicians, specialists, office staff, @entity1 , @entity6 educators, and others, were involved in the care improvement activities.
