Primary Care Diabetes Bundle Management: 3-Year Outcomes for Microvascular and Macrovascular Events | Page 3

Published Online: June 26, 2014
Frederick J. Bloom Jr, MD; Xiaowei Yan, PhD; Walter F. Stewart, PhD; Thomas R. Graf, MD; Tammy Anderer, PhD; Duane E. Davis, MD; Steven B. Pierdon, MD; James Pitcavage, MS; and Glenn D. Steele Jr, MD
Prior evidence indicates that it is possible to improve process of care measures for diabetes in clinical practice, 30 and document small to modest improvements in glycemic control.31 There is a single report of reduced adverse events (amputations, retinopathy, and MI) using a diabetes disease management program.32 If substantiated, our findings that a DS reduces the microvascular and macrovascular complications of diabetes in only 3 years have potentially important implications for patients, providers, and payers. 33

Take-Away Points

A diabetes system of care using an all-or-none bundled measure can reduce the microvascular and macrovascular complications of diabetes in only 3 years.

  • A system of care for diabetes can reduce myocardial infarction, stroke, and retinopathy in only 3 years.

  • Translation into a workable care protocol in primary care is challenging. Workflows were developed that were measurable, scalable, reliable, and not dependent on the diligence of individual providers.

  • Payers and health systems can innovate and invest together in the infrastructure to build similar systems of care, knowing that the benefit for their patients with diabetes will be prompt.
Author Affiliations: Geisinger Health System, Danville, PA (FJB, TRG, TA, DED, SBP, GDS); Sutter Health, Sacramento, CA (XY, WFS, JP).

Source of Funding: Geisinger Health Plan.

Author Disclosures: Drs Bloom and Graf report accepting fees from the Merck Speaker’s Bureau. Dr Davis reports employment with a group practice that operates as part of Geisinger Health System, from which data were used as part of this study. The other authors (XY, WFS, TA, SBP, JP, GDS) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (FJB, XY, WFS, TA, SBP, GDS); acquisition of data (FJB, XY, TA, SBP, JP, GDS); analysis and interpretation of data (FJB, XY, WFS, TA, JP, GDS); drafting of the manuscript (FJB, WFS, TA, DED, JP, GDS); critical revision of the manuscript for important intellectual content (FJB, XY, WFS, TA, DED, JP, GDS); statistical analysis (XY); obtaining funding (DED); administrative, technical, or logistic support (FJB, TA, SBP, JP, GDS); supervision (FJB, WFS, JP, GDS).

Address correspondence to: Frederick J. Bloom Jr, 100 N. Academy Ave, Danville, PA 17822-3836. E-mail: fbloom@geisinger.edu.
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Issue: June 2014
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