Thursday, February 24, 2011

Insights on Diabetes Management, Courtesy of Health Canada

The Disease Management Care Blog has completed day 1 of 2 of the Health Canada conference on Diabetes Management Programs. While it certainly had much to say in its presentation, the real treat was hearing from the other speakers.

Among the many insights are:

While Canadians are patriots and are loyal to their government-dominated health care system, they readily admit that there are two problems with it: 1) politics intrude in health care policy making and 2) year-to-year clinical program planning can be hostage to year-to-year budgetary funding.

One speaker independently concluded - without having previously read the DMCB - that delivery system redesign with improved scheduling, organization and multidisciplinary teaming with non-physician providers offers the greatest hope for the care of persons with chronic illness. Health information technology and decision support, on the other hand, has little impact on patient outcomes.

One Province allows "stickers" to be placed on the back of insurance cards that are recognized as standing orders by all government labs for regular blood testing, like A1Cs or lipid testing.

While nurse-educator patient coaches are associated with increases in diabetes testing, patients from the same clinics who have not interacted with the nurses also experience increases in testing. The nurses seem to "nudge" changes in physician behavior.

Physicians, clinics or larger systems seeking to achieve outcomes should expect to spend 10% of their budget on data management, analytics and statisticians.

Which diabetes interventions are truly cost saving? You may be surprised by the contrast between how many lead to increased costs and how many actually save money. The global answer, courtesy of the Diabetes Control Priorities Project is here.

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