Comparing health outcomes and primary care physician utilization among low-income adults with type 2 diabetes and/or hypertension receiving either standard or intensive care management
Creators: name: Galan, Javier
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Background: Care management programs aim to improve individual health outcomes by using care managers to assist with the integration of heterogeneous health care and social service components. Project Access of Durham County (PADC) and Local Access to Coordinated Healthcare (LATCH) administer a care management program to an uninsured and racially diverse population in Durham, North Carolina. This population experiences substantial disparities in type 2 diabetes and hypertension prevalence and secondary complications. PADC-LATCH administers this program through standard (SCM) and intensive (ICM) protocols. The intensive protocol consists of more frequent and comprehensive individual encounters and is reserved for individuals meeting specific criteria with respect to chronic disease diagnoses and/or uncontrolled chronic disease. This evaluation investigates baseline patient characteristics among the protocols, if each is being implemented appropriately, and the effect on clinical outcomes. Methods: Individuals having a recorded diagnosis of type 2 diabetes and/or hypertension and who were enrolled and receiving care management under the SCM (n=123) or ICM (n=23) protocols between January 1, 2015 and June 30, 2015 were considered in the final evaluation. Individual data were abstracted from care management notes and medical records. Data analysis was performed to investigate outcome changes within and across each group. Results: Mean age (ICM: 51.9 years ± 8.63, SCM: 51.2 years ± 10.4, P=0.78), baseline systolic (P=0.69), and diastolic blood pressure (P=0.078) were similar for both groups while baseline hemoglobin A1c differed significantly (P<0.05). Those enrolled in ICM experienced a reduction in HbA1c from 10.6 to 9.51% (P=0.1), an 8.76% decrease, compared to individuals in SCM who had a small increase in HbA1c from 6.73 to 6.78% (P=0.92), a 2.03% increase. The difference in percent change in HbA1c across groups was not statistically significant (P=0.09). Both groups saw non-significant reductions in both systolic (ICM: 141.6 ± 19.1 to 137.2 ± 18.6, P=0.17 and SCM: 143.5 ± 21.2 to 140.6 ± 18.9, P=0.19) and diastolic blood pressure values (ICM: 81.5 ± 11.2 to 79.8 ± 12.1, P=0.60 and SCM: 85.8 ± 10.8 to 84.5 ± 10.6, P=0.23). There was no statistically significant difference in percent change in systolic (P=0.46) and diastolic blood pressure values (P=0.99) across groups. Those receiving SCM had a statistically significant reduction in the proportion of PCP visits with a decrease of 16.7% (P<0.05) compared to a decrease of 0.8% (P=0.25) among individuals receiving ICM, with no significant difference between groups (P=0.39). Lastly, only 57.1% of ICM individuals achieved their care management goals compared to 78.2% of those enrolled in SCM (P<0.05). Conclusions: SCM and ICM protocols have varying results on outcomes of interest. Those enrolled in SCM saw a unexpected decrease in PCP utilization and achieved care management goals at a higher rate than counterparts receiving ICM. Individuals enrolled in the ICM protocol saw a decrease in HbA1c. Effects on blood pressure values were equivocal. This evaluation suggests that each protocol achieves desired results to varying degrees. As such, there should be considerations of modifying both protocols to improve their effects on clinical outcomes and PCP utilization.