Diabetes care: a comparison of management systems

During 1997, the Alaska Area Diabetes Program audited a sample of 837 charts from among the 1373 individuals receiving regular diabetes care at facilities serving predominantly American Indians/Alaska Natives. Charts were evaluated for the delivery of American Diabetes Association Standards of Care. Results of the audit showed a great deal of variability among facilities. Facilities which scored highly in the audit were more likely to use an organized multidisciplinary team approach that included coordinated clinic appointments with multiple providers on the same day, maintenance of a diabetes registry, proactive preclinic preparation, flow-sheet use, intensive individual nutritional counseling, a case manager or field clinic coordinator system with standing orders, and strong self-management support.