The Vermedx® Diabetes Information System Reduces Healthcare Utilization | Page 2

This analysis of paid claims from a physician hospital organization demonstrates that the Vermedx Diabetes Information System improves healthcare costs for adults with diabetes.

Published Online: March 16, 2009
Benjamin Littenberg, MD; Charles D. MacLean, MDCM; Karl Zygarowski, BS; Barbara H. Drapola, RN; James A. Duncan, MD; and Clifford R. Frank, MHSA
Because the DIS does not directly change the flow of patients through the practice or require data entry, new staffing, or capital equipment, it is well accepted by primary care practices. Likewise, patients are generally pleased with the service. Less than 3% of patients opt not to participate in the DIS.8

What would be the economic effect of wide deployment of the DIS? The number of US adults diagnosed as having diabetes in 2007 was 17.4 million.2 Assuming that only 75% receive primary care and 5% of those patients will refuse the service, and conservatively estimating savings at $2000 per patient per year after deducting the costs of the service, healthcare utilization could be reduced by $24 billion per year in America.

This analysis is subject to certain limitations. The sample is small and represents 1 insurer in 1 region. Paid claims per month are variable, with positive outliers. However, eliminating extreme outliers had little effect on the results. As in any nonrandomized study, the observed associations may be  confounded by unmeasured differences between the 2 groups. The results seen herein do not apply to other disease management, cost reduction interventions, or conditions.

In conclusion, participation in the DIS is associated with substantial reductions in claims paid, net of the costs of the intervention. Savings range from $504 per patient in the first year of participation to $3563 in the fourth year. Therefore, the cost savings reported in the randomized clinical trial of the DIS are reproduced in an independent data set.

Author Affiliations: From the Department of Medicine (BL, CDM), University of Vermont, Burlington, and Vermont Managed Care, Inc (KZ, BHD, JAD, CRF), Colchester.

Funding Source: This work was funded in part by the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK61167 and K24 of this work.

Author Disclosure: Drs Littenberg and MacLean hold equity in Vermont Clinical Decision Support, LLC, which distributes the Vermedx Diabetes Information System. Mr Zygarowski, Ms Drapola, Dr Duncan, and Mr Frank are
employees of Vermont Managed Care, Inc, which purchases Vermedx Diabetes Information System services for its subscribers.

Authorship Information: Concept and design (BL, CDM, KZ, BHD, CRF); acquisition of data (BL, CDM, KZ, CRF); analysis and interpretation of data (BL, CDM, BHD, JAD, CRF); drafting of the manuscript (BL, JAD); critical revision of the manuscript for important intellectual content (BL, CDM, KZ, BHD, JAD, CRF); statistical analysis (BL, CRF); provision of study materials or patients (KZ, CRF); obtaining funding (BL); and administrative, technical, or logistic support (KZ, BHD).

Address correspondence to: Benjamin Littenberg, MD, Department of Medicine, University of Vermont, 371 Pearl St, Burlington, VT 05401. E-mail:

1. Saaddine JB, Cadwell B, Gregg EW, et al. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002. Ann Intern Med. 2006;144(7):465-474.
2. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007 [published correction appears in Diabetes Care. 2008;31(6):1271]. Diabetes Care. 2008;31(3):596-615.
3. Wagner EH, Glasgow RE, Davis C, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27(2):63-80.
4. MacLean CD, Littenberg B, Gagnon MS, Reardon M, Turner PD, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices. Clin Trials. 2004;1(6):532-544.
5. MacLean CD, Littenberg B, Gagnon M. Diabetes decision support: initial experience with the Vermont Diabetes Information System. Am J Public Health. 2006;96(4):593-595.
6. Cleveland WS. Visualizing Data. Summit, NJ: Hobart Press; 1993.
7. Rogers WH. Regression standard errors in clustered samples. STATA Technical Bull. 1993;13:19-23.
8. Littenberg B, MacLean CD. Passive consent for clinical research in the age of HIPAA. J Gen Intern Med. 2006;21(3):207-211.

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